[Calculation of Standardised Unit Costs for the Economic Evaluation of Mental Disorders]. / Kostensätze zur monetären Bewertung von Versorgungsleistungen bei psychischen Erkrankungen.

Introduction: Assessing resource utilisation and costs for treating mental disorders in Germany is difficult. This pertains especially to the numerous non-medical services that are financed by a considerable number of payers. To standardise and simplify cost calculation, we created a database of unit costs for the most important services for mental disorders. Method: We performed a literature and internet search to identify services provided to persons with mental disorders. Unit costs were calculated either by means of public statistics or data directly obtained from payers. If data could not be obtained that way, health care providers were interviewed to collect data relevant for cost estimation. Results: Unit costs were calculated for medical and vocational rehabilitation, assisted living, sociopsychiatric services, counselling centres, daycare facilities, ambulant psychiatric nursing care, occupational therapy, sociotherapy, psychoeducation, caretaker, domestic help, creative therapies, physical therapy, and relaxation techniques. Discussion and Conclusion: Calculating unit costs for non-medical services was essential, since these services constitute a central element in the treatment of persons with mental disorders. Nevertheless, the large amount of different services and payers complicated a comprehensive assessment of costs. Thus, uncertainty associated with the calculation of costs should be taken into account.

Cost measurement of mental disorders in Germany.

BACKGROUND AND AIMS OF THE STUDY: Mental disorders are frequently investigated in economic evaluations. However, measuring direct costs of mental disorders is complex, in particular in Germany. We conducted a systematic review that investigated the following research questions: Which cost categories are assessed? Is the used data source (patient-reported data from interviews or questionnaires; claims data from health insurance; medical records from patient charts) associated with specific study characteristics? METHODS: We conducted a systematic literature search in PubMed. We included cost-of-illness studies (COIs) and cost-effectiveness analyses (CEAs) that measured patient level data on direct costs of mental disorders in Germany. RESULTS: We found 31 COIs and 17 CEAs. Cost items could be assigned to the cost categories outpatient medical, outpatient non-medical, sheltered living, hospital, rehabilitation, nursing care, outpatient goods (medication and medical goods), other direct costs, and indirect costs. Most studies, in particular COIs and studies conducted from a societal perspective, used patient-reported data which suited to assess cost categories comprehensively. Studies based on claims data or medical records tended to include fewer cost categories. DISCUSSION: The sample size of 48 analyzed studies was rather small. However, our study investigated three methods to assess health care utilization -- using patient-reported data, claims data, or medical records -- and identified their respective strengths and weaknesses in the context of covered cost categories and further attributes. CONCLUSION: Studies measuring the direct costs of mental disorders in Germany mostly relied on patient-reported data to assess resource consumption. Although more objective, claims data were used less frequently and covered less cost categories. IMPLICATIONS FOR HEALTH POLICIES: The direct costs of mental disorders are likely to be underreported as relevant cost factors such as non-medical services or sheltered living were often neglected in the studies. Policy makers should consider this when deciding on measures that aim at reducing the costs of care. IMPLICATIONS FOR FURTHER RESEARCH: Eliciting data from patients seems to constitute an adequate instrument to assess a broad range of cost categories, even though this bears various methodological challenges. Further research should (i) ameliorate the methods of collecting data from patients in ensuring that all relevant costs are covered and that methodological flaws are minimised (ii) develop or improve methods for the combination of claims data from different data holders.

[FIMPsy - Questionnaire for the Assessment of Medical and non Medical Resource Utilisation in Mental Disorders: Development and Application]. / FIMPsy ­ Fragebogen zur Inanspruchnahme medizinischer und nicht medizinischer Versorgungsleistungen bei psychischen Erkrankungen: Entwicklung und Verwendung.

OBJECTIVE: In Germany, patients with mental disorders can benefit from many medical and non-medical services. However, assessing the consumption of these services is difficult. We developed the questionnaire FIMPsy that can be used to assess health care consumption in patients with mental disorders and thereby facilitate economic evaluations. METHODS: We identified relevant medical and non-medical services for patients with mental disorders and included frequently consumed services in the questionnaire. RESULTS: FIMPsy can be utilized to assess the consumption of the following services in the preceding six months retrospectively: informal care, psychiatric counselling, psychosocial care, assisted living and occupational integration. Furthermore, FIMPsy assesses contacts with outpatient and inpatient medical providers as well as the intake of medication. CONCLUSION: FIMPsy covers many services for patients with mental disorders. It can be applied in economic evaluations and thus facilitate and standardize their implementation.

Excess costs from functional somatic syndromes in Germany - An analysis using entropy balancing.

AIM: The aim of this study was to calculate disorder-specific excess costs in patients with functional somatic syndromes (FSS). METHODS: We compared 6-month direct and indirect costs in a patient group with FSS (n=273) to a control group of the general adult population in Germany without FSS (n=2914). Data on the patient group were collected between 2007 and 2009 in a randomized controlled trial (speciAL). Data on the control group were obtained from a telephone survey, representative for the general German population, conducted in 2014. Covariate balance between the patient group and the control group was achieved using entropy balancing. Excess costs were calculated by estimating generalized linear models and two-part models for direct costs and indirect costs. Further, we estimated excess costs according to the level of somatic symptom severity (SSS). RESULTS: FSS patients differed significantly from the control group regarding 6-month costs of outpatient physicians (+€280) and other outpatient providers (+€74). According to SSS, significantly higher outpatient physician costs were found for mild (+€151), moderate (+€306) and severe (+€376) SSS. We also found significantly higher costs of other outpatient providers in patients with mild, moderate and severe SSS. Regarding costs of rehabilitation and hospital treatments, FSS patients did not differ significantly from the control group for any level of SSS. Indirect costs were significantly higher in patients with severe SSS (+€760). CONCLUSION: FSS were of major importance in the outpatient sector. Further, we found significantly higher indirect costs in patients with severe SSS.

Health care utilisation and costs in the general population in Germany.

AIM: To elicit reference values of medical and non-medical health care utilisation and costs in Germany from a societal perspective. METHODS: 5007 telephone interviews were conducted in a representative sample of the German-speaking population above the age of 18. Participants were asked about medical and non-medical health care utilisation over the preceding six months. Participants were also asked about medical conditions, lifestyle, sociodemographic characteristics, employment status and sick leave. Resource utilisation was valued monetarily and analysed by means of descriptive and econometric tools (generalised linear models/two-part models). To obtain representative results, we weighted observations according to age, gender, education and state of residence. RESULTS: 95% of the respondents had at least one contact with an outpatient physician. 12% of the respondents were hospitalised and 3% received rehabilitative care. Direct costs per respondent were €1475 on average. The mean cost of physician visits was €278. We found differences in average costs for physician visits between men (€232) and women (€321). Indirect costs were €1554 on average per full-time employee. Multivariate analysis showed significant associations between direct costs and morbidity, age and gender. Indirect costs appeared to be significantly associated with morbidity and age, but not with gender. CONCLUSION: Our reference values can be regarded as representative reference values for health care utilisation and costs, and can be used for the calculation of disease-specific excess costs.