About this Journal

Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 2, Issue 1, 1999. Pages: 13-19

Published Online: 8 Jun 1999

Copyright © 1999 John Wiley & Sons, Ltd.

 Research Article
Incorporating economic analysis in evidence-based guidelines for mental health: the profile approach
James Mason 1 *, Martin Eccles 2, Nick Freemantle 1, Michael Drummond 1
1Centre for Health Economics, University of York, UK
2Centre for Health Services Research, University of Newcastle upon Tyne, UK
email: James Mason (jnm7@york.ac.uk)

*Correspondence to James Mason, Medicines Evaluation Group, Centre for Health Economics, University of York, Heslington, York, YO1 5DD, UK


Many western health systems are currently developing the role of clinical guidelines to promote effective and efficient health care. However, introducing economic data into guideline methodology designed to assess the effectiveness of interventions raises some methodological issues. These include providing valid and generalizable cost estimates, the weight placed upon cost "evidence" and presenting cost-effectiveness information in a way that is helpful to clinicians.

Aim of the Study
To explore a framework for including economic concepts in the development of a series of primary care guidelines, two of which address mental health conditions.

A profile approach, setting out best available evidence about the attributes of treatment choices (effectiveness, tolerability, safety, health service delivery, quality of life, resource use and cost), was used to help clinicians to derive treatment recommendations in a manner consistent with both the clinical decision-making process and social objectives.

Clinicians involved in guideline development responded well to the process. Although there was often considerable debate about the meaning and importance of different aspects of evidence about treatment, in none of the guideline groups was there failure to agree treatment recommendations.

The profile approach may be particularly useful in the field of mental health where disease processes may often feature very disparate effects, over long periods of time and impacting upon a broad circle of relatives, carers and agencies in addition to the patients themselves.

A method has been applied in a series of primary care guidelines, which appears to enable clinicians to consider the issue of resource use alongside the various clinical attributes associated with treatment decisions. The basis of this work is the belief that guidance presenting physical measures describing effectiveness, adverse events, safety, compliance and quality of life, alongside resource consequences, is most likely to appropriately inform doctor-patient interactions.

Implications for Health Care Provision and Use
This research may provide a useful platform for other groups considering how to introduce cost-effectiveness concepts into guideline development groups. Whether guidelines change clinical behaviour remains a research question, and the subject of forthcoming trials.

Implications for Health policy Formulation
It is important that government agencies realize that guideline development is a health policy tool with prescribed methods to produce valid guidelines. Attempts to tamper with the methodology for cost-containment purposes or other political reasons are likely to discredit a useful mechanism for improving the scientific basis of health care provision.

Implications for Further Research
There are a number of limitations to completed work: for example it has a primary care focus and addresses fairly narrowly defined conditions. Work is ongoing to extend the scope to broader disease areas and to secondary care. Copyright © 1999 John Wiley & Sons, Ltd.

Received: 10 October 1998; Accepted: 22 February 1999