Meeting Summary
Preventing Child and Adolescent Mental Disorders: Research Roundtable on Economic Burden and Cost Effectiveness
February 25, 2004
Rockville, Maryland
On February 25, 2004, an NIMH roundtable meeting brought together preventive interventionists, methodologists, and economists to discuss what is known about the economic burden of mental illness in children and adolescents and the cost effectiveness of preventive interventions.
Brief Overview: Estimating the economic burden of mental illness for children and adolescents
Very little research has systematically addressed estimating the burden of mental illness in children and adolescents. In 1998, the direct costs for the treatment of child mental health problems (emotional and behavioral) were approximately $11.75 billion or $173 per child (Sturm et al., 2000; Ringel & Sturm, 2001). This study included the cost of services provided by health and mental health professionals to treat mental illness. The authors pointed out that one of the many reasons why national health expenditures for child/adolescent mental disorders are difficult to estimate is that mental health services are delivered and paid for not only in the health and mental health sectors, but also in the education, child welfare, and juvenile justice sectors and no comprehensive national datasets exist in this area. Indirect costs associated with mental illness (such as future lost wages as a consequence of worse educational attainment) were not included in the Sturm et al. project. This is an understudied area, however an important component of the economic burden of child/adolescent mental disorders.
Child and adolescent preventive interventions have the potential to reduce the economic burden of mental illness through the reduction of need for mental health and other related services (economic inputs) and increasing the potential benefits of positive developmental outcomes (economic outputs; e.g., educational attainment, economic productivity, etc.), representing net societal savings. During the meeting several issues related to estimating the burden of mental illness for children and adolescents were discussed, including the following examples.
Challenges and opportunities in estimating the economic burden of child and adolescent mental disorders:
- Because many benefits of preventive interventions may be outside the mental health services systems (criminal justice, general medical services, education), considerations of program costs and benefits may need to involve multiple stakeholders across separate systems.
- It is difficult to estimate costs of rare and often expensive events such as suicide and serious criminal acts, thus meta-analyses of multiple trials and/or more robust predictors are needed.
- National datasets of child and adolescent health (e.g., National Longitudinal Survey of Youth), due to larger population samples, may provide opportunities to estimate the burden of mental illness in children and adolescents. Future supplements to such datasets should consider including data on mental health outcomes that can be linked to economic indicators such as service use, and information about risk factors for mental disorders.
- Similarly, prevention trials that test specific causal models of intervention should try to include common measures for estimating the economic burden of mental illness in youth. Information on economic burden in well-defined populations provides necessary complements to national estimates that will have limited contextual information, as well as limited longitudinal information. Because most prevention trials examine outcomes over time, they also provide information on early trajectories of mental health and possible economic outcomes.
Currently few NIMH-funded prevention trials for child and adolescent mental disorders include economic analysis of either the costs/benefits or the cost effectiveness of the intervention. During the roundtable, the group discussed methodological issues related to adding economic studies to existing prevention trials, plans for economic analysis during the initial phase of testing interventions (e.g., efficacy) as well as later phases of intervention and services research (e.g., effectiveness, implementation, dissemination).
Methodological challenges and opportunities in conducting economic evaluation of child and adolescent preventive interventions:
- Most prevention trials are fielded within service settings (education, managed care, early childhood education programs) where potential “purchasers” of the intervention often have a vested interest in the costing out of “treatment as usual” as well as costs of the intervention program. At a minimum, including cost assessment in an efficacy trial is necessary to inform purchasers about the approximate costs of the intervention.
- Many trials do not have adequate statistical power to conduct economic analysis. Identification of common measures and development of conceptual frameworks that could be used across prevention trials, to allow pooling of data, could help address this limitation.
- In trials of preventive interventions that include sustainability efforts, costs that real world settings would incur for maintaining intervention fidelity should be developed (quality control costs).
Opportunities for learning more about the impact of preventive interventions on reducing the economic burden of mental illness in children and adolescents:
This meeting was an opportunity for researchers from different disciplines to discuss the potential impact of preventive interventions on reducing the burden of mental illness in children and adolescents. Yet other scientific disciplines and stakeholder groups may need to enter into this discussion. As the meeting concluded, the group expressed the need for additional interdisciplinary meetings of these issues, including further consideration of interdisciplinary methodological approaches.
References
Sturm, R., Ringel, J., Bao, C., Stein, B., Kapur, K., Zhang, W., & Zeng, F. National Estimates of Mental Health Utilization and Expenditures for Children in 1998 (November 2000). Working Paper No. 205. In National Advisory Mental Health Council’s Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment (2001). Blueprint for Change: Research on Child and Adolescent Mental Health. Rockville, MD: National Institute of Mental Health. NIH Publication No. 01-4985, p. 93.
Ringel, J.S., & Sturm, R. (2001). National Estimates of Mental Health Utilization and Expenditures for Children in 1998. Journal of Behavioral Health Services Research, 28(3), 319-333.
