PERSPECTIVE: Health Economic Interests at NIMH and NIDA to Improve Delivery of Behavioral Health Services.

BACKGROUND: Effective financing mechanisms are essential to ensuring that people can access and utilize effective treatments and services. Financing mechanisms are needed not only to pay for the delivery of those treatments and services, but also ancillary costs, while also keeping care affordable. AIMS: This article highlights key areas of the interest of the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) in supporting applied health economics and health care financing research. Specifically, this article discusses the long-range impact of NIH's earlier investments in applied health economics research, and NIH's ongoing efforts to communicate its interests in health economics research. We discuss the 2023 NIMH-NIDA-sponsored health economics conference, and the ideas presented there for developing and assessing innovative behavioral health care financing models; three of the presented papers were recently published in the Journal of Mental Health Policy and Economics. METHODS: We describe the history and impact of NIMH- and NIDA-sponsored economic research and identify current research interests as identified in the NIMH and NIDA Strategic Plans and recent funding announcements. We examine themes presented at the NIMH-NIDA Health Economics conference. The conference included over 300 participants from 20 countries, from six continents. RESULTS: The topics highlighted at the conference highlight the ways in which NIH-funded research has promoted the development of innovative health care financing methods, both from the supply side (e.g., providers and payers) and demand side (e.g., service users and families). Invited speakers discussed the findings from NIH-supported research in the topic areas of payment and financing, behavioral economics and social determinants of health. Keynote speakers highlighted emerging topics in the field, including the economics of health equity, biases in mental health models in health care, and value-based insurance design. DISCUSSION: We demonstrate a resurgence of and explicit interest in health economics and policy research at NIMH and NIDA. However, more work is needed in order to design funding mechanisms that fully provide access to and facilitate use of effective evidence-based practices to improve mental health outcomes. For example, it is important that policy and health economic research projects include decision makers who will be the end users of data and study results, to ensure that results can be meaningfully put into practice. IMPLICATIONS FOR HEALTH CARE: Designing effective and efficient funding mechanisms can help ensure that service users have access to effective treatments and that clinicians and provider organizations are adequately compensated for their work. IMPLICATIONS FOR HEALTH POLICIES: Federal, state, and local policies, as well as policies of payers and health care organizations, can influence the type of care that is supported and incentivized. IMPLICATIONS FOR FURTHER RESEARCH: As demonstrated by the research interests as outlined in their respective Strategic Plans and funding announcements, NIMH and NIDA continue to fund health economic and policy research that aims to improve health care access, quality and outcomes for people with or at risk of developing behavioral health conditions in the US and around the world.

PERSPECTIVE: Current US COVID-19 Pandemic Substance Use Research and Ideas for Research That May Help Us Learn More.

BACKGROUND: The COVID-19 pandemic likely had and will continue to have severe implications for those who use addictive substances, have substance use disorders, or use substance use related health care services. Policy and services research, particularly health economics research, can illuminate these effects on individuals, uncover the effects of the rapidly imposed changes in policy on how services were delivered, promote efficient and effective provision of services, and inform responses to future pandemics. AIMS OF THE STUDY: To identify potential substance use related effects of COVID-19 and pandemic mitigation policies, highlight themes in current research, and suggest areas for further high-quality policy and services research, with an emphasis on health economics research. METHODS: Review of recent published commentaries, government documents, and initial research findings to describe potential impacts, and review of current COVID-19 related research grants funded by the United States National Institutes of Health to identify themes. RESULTS: Potential impacts include increased risk for and severity of COVID-19 illness among those who use substances, mitigation measures causing increased substance use and development of use disorders, and fundamental changes in the way treatment is provided. Current research may provide initial findings that may be useful in generating hypotheses for future rigorous research. DISCUSSION: Research on these and other areas could enhance our fundamental understanding of the needs of individuals who use substances and how to best address those needs in the most efficient, effective way. Though this brief review highlights some areas of potential interest, its focus is mainly on treatment and on the United States context. Research on additional services and contexts likely could inform advances as well. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Health care providers rapidly and under considerable stress made needed changes that likely mitigated SARS-CoV-2 transmission. Rigorous research can help determine what worked best and for whom, what could be kept, and what might better be discarded. IMPLICATIONS FOR HEALTH POLICIES: Research on the effects of mitigation policies may inform the development of policies to reduce negative effects when addressing future pandemics, whether to permanently allow at least some substance use treatment flexibilities, and whether research on other restrictive policies might lead to improvement. IMPLICATIONS FOR FURTHER RESEARCH: This extraordinary event brought into sharp relief the numerous vulnerabilities of those who use substances and those with substance use disorders while also leading to vast changes in the services that address them. Rigorous research into those effects could result in significant improvements in policy and practice.

Economic analysis in behavioral health: Toward application of standardized methodologies.

Health care remains the most expensive sector in the U.S. economy, now accounting for nearly 1 in every 5 dollars spent. The purpose of health care is to improve the health of populations. However, formal medical care is one of many alternatives for improving health. In order to make better use of scarce resources, cost-effectiveness methodologies have been developed to evaluate how to produce the most health within the constraints of available resources. Standardized cost-effectiveness methodologies are now commonly used in the evaluation of medical therapies and new technologies. However, these methods have rarely been employed for the evaluation of behavioral interventions. Behavioral interventions often use measures that are not generally applied in other areas of health outcomes research. A consequence of neglecting to employ standardized cost-effectiveness analysis is that behavioral, psychological, and environmental interventions may be left out of resource allocation discussions. The purpose of this paper is to review standardized approaches to cost-effectiveness analysis and to encourage their use for the evaluation of behavioral intervention programs. Application of standardized methods of cost-effectiveness analysis will allow direct comparisons between investing in behavioral interventions programs in comparison to a wide range of other alternatives. The methods are general and can be used to estimate the cost-effectiveness of social and environmental interventions in addition to traditional medical and surgical treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Formal treatment, self-help, or no treatment for alcohol-use disorders? Evidence from the National Household Survey on Drug Abuse.

OBJECTIVE: The purpose of this study was to examine further alcohol treatment choice by using data from a nationally representative sample of adults with alcohol-use disorders to test which of three models-sequential, multinomial, or nested best fit the data. The goals were to provide evidence about how this choice was made and to provide improved coefficient estimates, as well as to inform future analyses of treatment choice. METHOD: Data from the 2000 National Household Survey of Drug Abuse include respondents ages 18-64 reporting symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of alcohol abuse or dependence. A nested multinomial framework is used to determine the preferred model and to estimate the effect of respondents' characteristics on the decisions to receive help and what kind of help to receive. RESULTS: A sequential model, in which the choice of whether to receive help is unaffected by the level of satisfaction afforded by the alternatives, best fit the data. Older respondents had higher odds of both receiving help and choosing self-help, and those with a DSM-IV diagnosis of abuse had lower odds of receiving help but higher odds of entering self-help. CONCLUSIONS: The decision to receive help for alcohol problems appears unaffected by the perceived differences between these two broad categories of alternatives: self-help or formal treatment. This result may indicate the need to provide more information on the full range of treatment options to those for whom self-help may not be sufficient.