Cost-Outcome Methods for Mental Health


  • William Hargreaves, University of California, San Francisco, U.S.A.
  • Martha Shumway, University of California, San Francisco, U.S.A.
  • Chou Li-Wei, MD MSc
  • Brian Cuffel, United Behavioral Health, San Francisco, California, U.S.A.

Cost-Outcome Methods for Mental Health provides an overview of the choices and judgments used to evaluate the cost effectiveness of mental health treatment. It presents economic concepts of cost, discusses the various approaches to cost-outcome studies, and focuses on the way such studies apply to mental health. It is a practical guide rather than a theoretical treatment of cost-effectiveness analyses. Readers are guided through the process of designing cost-outcome studies; measuring costs, interventions, and outcomes; analyzing study results; and using findings to guide policy and practice. The book introduces readers who do not have a background in economics to apply economic methods of cost-outcome research, and prepares them for productive collaboration with economists in mental health services research.
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Graduate students, faculty members, and professionals specializing in psychiatry and working in the fields on mental health services research, mental health policy, and health economics. Also mental health services researchers, clinical investigators, program managers, and policy planners in insurance firms and government.


Book information

  • Published: October 1997
  • ISBN: 978-0-12-325155-8


"In summary, this book would serve as an excellent resource for graduates and postgraduates involved in mental health outcome research. While many chapters are technical and dense in nature, this book was exciting to read in that it encouraged me, as a scientist-practitioner, to consider innovative models for integrating fiscal responsibility with effective service delivery."

"This excellent book is engaging, clear, practical, and scientifically sound. It will enable mental health services researchers from a variety of backgrounds both to understand the literature on cost studies and to participate in such studies. Clearly the best available primer in the field, it should be a welcome resource for researchers and students alike."
--ROBERT E. DRAKE, M.D., Professor of Psychiatry, Psychiatric Research Center, Lebanon, New Hampshire
"This book combines the right authors with a timely and useful subject. Like their previous works, it is certain to be well received."
--HOWARD H. GOLDMAN, M.D., Professor of Psychiatry, University of Maryland School of Medicine, Baltimore
Cost-Outcome Methods for Mental Health is a timely textbook that helps fill a yawning gap in mental health services research - a field that has produced so few published cost-outcomes studies that the authors resort to examples from medicine rather than mental health. Recognizing the elementary phase of development of the field, the authors wisely point out that their goal is to help readers learn a new vocabulary and become intelligent consumers of cost-outcome research findings."
--Barbara Dickey, Ph.D. in PSYCHIATRIC SERVICES, April 1999
"A great virtue of this book - in addition to its excellent attention to "how to" - is its focus on "why": why we have a responsibility to understand costs in addition to outcomes in mental health treatment research. The book highlights the fact that analysis of costs goes beyond statistics, into societal values...Perhaps the greatest strength of this book, however, is its extraordinary clarity in describing how to actually conduct cost-outcome research."
"This book provides a primer of cost-outcome methods in mental health services research. The authors' intention is to introduce those without a background in economics to 'applied economic methods of costoutcome research' and those with a background in research design and statistics to the specific methods of 'services research in mental health.' With ten chapters... the book provides a comprehensive description of many issues of cost-outcome research, and contains numerous useful examples for those new to mental health services research as well as to applied economic analysis. The book may also be suitable as a basic text for a graduate seminar in cost-outcome methods in mental health if it is supplemented with primary source material...Overall, this book accomplishes what no other text in the field has yet to do--it covers ground that will be useful to both health economists and mental health outcome researchers... The authors have accomplished no small feat in providing the field with a valuable new reference that provides a fair and reasoned summary of cost-outcome methods for mental health."
"The book is a practical guide rather than a theoretical treatment of cost-effectiveness analysis. Toward this end, readers who do not have a background in economics are introduced to the application of economic methods of cost-outcome research, and are prepared for productive collaboration with economists in mental health services research."
"This very welcome book by Bill Hargreaves and colleagues both capitalizes on and contributes to this developing mental health economics niche...Niche markets need niche textbooks. This is an excellent example of that genre, in this case a demand side textbook. The qualified or experienced health economist looking to work in the mental health field would find the book useful for its richness in examples, but the primary market-particularly outside the U.S.-is the psychiatrist, psychologist, mental health nurse, psychotherapist or mental health 'manager'. These professionals are faced with 'economic' decision every day, and are increasingly looking for informed, well-based guidance. This book ought to help enormously... The authors of this very readable book are rightly renowned for the quality (and quantity) of their work on mental health economics (and certainly not just in cost-outcomes research). Their experience and expertise shine through. Together they have authored a book that will greatly assist non-economists in the mental health field to get to grips with the principles and practice of economic evaluation."
--Martin Knapp, Institute of Psychiatry and London School of Economics, U.K., in HEALTH ECONOMICS (8: 555-556, 1999)

Table of Contents

Preface.Chapter 1. Cost-Outcome Research in Mental Health. Real World Information for Decision Makeres. Mental Health Cost-Outcome Studies: A Brief Review. Overcoming Obstacles to Cost-Outcome Research in Mental Health. Chapter Review.Chapter 2. Special Design Issues in Cost-Outcome Research. Introduction to Study Design and Terminology. Internal Validity. External Validity. Specifying and Measuring Important Design Constructs. Statistical Conclusion Validity in Cost-Outcome Studies. Chapter Review.Chapter 3. Concepts of Economic Cost. Models for Cost-Outcome Analysis. Economic Theory and Cost-Outcome Analysis. Definitions of Economic Cost. Analytic Perspective. Chapter Review.Chapter 4. Measuring Utilization. Choosing the Types of Costs to Include. Mental Health Treatment Costs. Physical Health Care Costs. Criminal Justice Costs. Social Service Costs. Time and Productivity Costs. Other Family Costs. Transfers and Other Income. Sources of Data on Resource Utilization. Identifying and Selecting Resource Units. Practical Steps to Improve Data Quality. Chapter ReviewChapter 5. Estimating Economic Cost. Sources of Cost Data. Estimating Resource Costs. Adjusting Cost Estimates. Chapter Review.Chapter 6. Measuring Service Practice. Why Measure Service Practices? Measuring Service Practice: The Special Challenge of Cost-Outcome Research. Treatment Theory: A Guide to Measuring Practices. Developing a Service Model Specification. Measurement Approaches. Existing Measures. Using Practice Data in Cost-Outcome Research. Future Developments. Chapter Review.Chapter 7. Measuring Mental Health Outcomes. Measurement Challenges in Effectiveness Research. Conceptual Framework for Outcome Measurement. Specific Outcome Instruments. Future Directions in Outcome Measurement. Chapter ReviewChapter 8. Aggregating Outcome Measures. Approaches to Outcome Aggregation. Methods of Measuring Preferences. Quality-Adjusted Life Years. Discounting Outcomes. Chapter Review.Chapter 9. Analyzing Cost-Effectiveness. Making Cost-Effectiveness Comparisons: Basic Concepts. Procedures for Computing Cost-Effectiveness Ratios. Statistical Inference in Cost-Effectiveness Comparison. Additional Issues in Cost-Effectiveness Analysis. Chapter Review.Chapter 10. Using Cost-Outcome Data to Guide Policy and Practice. When Is Mental Health Policy Needed? Research Contributions to Mental Health Policy. Integrating the Findings from Multiple Studies. Future Developments in Applying Research to Policy. Chapter Review.Bibliography. Index.