Zechmeister Ingrid, Kilian Reinhold, McDaid David
Senior lecturer at the University of Ulm, Department of Psychiatry II, BKH Guenzburg, Ludwig-Heilmeyer-Str, 2, D-89312 Guenzburg, Germany.
BMC Public Health. 2008 Jan 22;8:20. doi: 10.1186/1471-2458-8-20.
While evidence on the cost of mental illness is growing, little is known about the cost-effectiveness of programmes in the areas of mental health promotion (MHP) and mental disorder prevention (MDP). The paper aims at identifying and assessing economic evaluations in both these areas to support evidence based prioritisation of resource allocation.
A systematic review of health and non health related bibliographic databases, complemented by a hand search of key journals and analysis of grey literature has been carried out. Study characteristics and results were qualitatively summarised. Economic evaluations of programmes that address mental health outcome parameters directly, those that address relevant risk factors of mental illness, as well as suicide prevention interventions were included, while evaluations of drug therapies were excluded.
14 studies fulfilled the inclusion criteria. They varied in terms of topic addressed, intervention used and study quality. Robust evidence on cost-effectiveness is still limited to a very small number of interventions with restricted scope for generalisability and transferability. The most favourable results are related to early childhood development programmes.
Prioritisation between MHP and MDP interventions requires more country and population-specific economic evaluations. There is also scope to retrospectively add economic analyses to existing effectiveness studies. The nature of promotion and prevention suggests that innovative approaches to economic evaluation that augment this with information on the challenges of implementation and uptake of interventions need further development.
尽管关于精神疾病成本的证据越来越多，但对于心理健康促进（MHP）和精神障碍预防（MDP）领域项目的成本效益却知之甚少。本文旨在识别和评估这两个领域的经济评估，以支持基于证据的资源分配优先级确定。
对健康和非健康相关的书目数据库进行了系统综述，并辅以对关键期刊的手工检索和灰色文献分析。对研究特征和结果进行了定性总结。纳入了直接涉及心理健康结果参数的项目、涉及精神疾病相关风险因素的项目以及自杀预防干预措施的经济评估，而排除了药物治疗的评估。
14项研究符合纳入标准。它们在所涉及的主题、使用的干预措施和研究质量方面各不相同。关于成本效益的有力证据仍然仅限于极少数干预措施，其可推广性和可转移性范围有限。最有利的结果与幼儿发展项目有关。
在MHP和MDP干预措施之间确定优先级需要更多针对具体国家和人群的经济评估。也有空间对现有有效性研究进行回顾性经济分析。促进和预防的性质表明，需要进一步开发创新的经济评估方法，通过关于干预措施实施和采用挑战的信息来增强评估。
