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The Cost-Effectiveness of Behavioral Health Interventions

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The Cost-Effectiveness of Behavioral Health Interventions Best Practices in the Behavioral Management of Chronic Disease: Volume IV The Cost-Effectiveness of Behavioral Health Interventions Supriya Misra, M.A. and Jodie A. Trafton, Ph.D. Published by: Institute for Disease Management A Division of Institute for Brain Potential 2 Best Practices in the Behavioral Management of Chronic Disease: Volume IV The Cost-Effectiveness of Behavioral Health Interventions Supriya Misra, M.A. & Jodie A. Trafton, Ph.D. Published by: Institute for Disease Management A Division of Institute for Brain Potential 1 ABOUT THE AUTHORS Supriya Misra, M.A. is a doctoral candidate at the Harvard T.H. Chan School of Public Health. She received her graduate and undergraduate degrees in Psychology, with a focus in Neuroscience, at Stanford University, and has years of management and research experience in the development and implementation of evidence-based health education and health technology to promote behavior change for both communicable and non-communicable diseases. Jodie A. Trafton, Ph.D. is Director of the Program Evaluation and Resource Center for the Veterans Health Administration’s National Office of Mental Health Operations. She also trains graduate and post-doctoral researchers and mental health professionals as an affiliated Clinical Associate Professor at Stanford Medical School Department of Psychiatry and Behavioral Sciences and the Center for Health Policy, and is Director of Publications at Institute for Brain Potential. Dr. Trafton is responsible for development of data-based management systems for mental health programs in the Veterans Health Administrations 141 health care systems, which together constitute one of the largest integrated mental health care systems in the world. These management systems include (1) performance measurement systems, (2) business intelligence systems for strategic capacity planning, productivity management, monitoring staff and patient satisfaction, and ensuring timely local availability of evidence-based clinical programming in alignment with enrollees’ clinical needs, (3) clinical quality management and decision support tools to track alignment of clinical practice patterns with guideline recommended care, and identify patients who might benefit from changes in treatment plan or additional services, (4) technical assistance programs that engage challenged mental health programs in problem- solving and action planning, train program managers and clinicians in data interpretation and use, and foster sharing of best practices, and (5) implementation and evaluation of innovative pilot programs to address emergent health care delivery challenges. The management systems enable decision-making at the patient, provider, clinic manager, and hospital management level to continually improve access to effective, high quality mental health services for Veterans across the United States. Here, the authors have applied their knowledge and experience to develop this text, concisely but thoroughly presenting the evidence-base for cost-effectiveness of behavioral and mental health interventions to guide health care managers in design of clinical and cost-effective services. Acknowledgements: We would like to acknowledge the editorial assistance of Linda Worsley and Austin Frakt, Ph.D. Supriya Misra, M.A. and Jodie A. Trafton, Ph.D. This book is not intended as a substitute for the medical recommendation of physicians or other healthcare providers. Neither the authors nor the publisher shall be liable or responsible for any health, welfare or subsequent damage allegedly arising from the use of any information contained in this book. All guidelines and discussions are presented as examples or generalized information only and should never be used as the basis for a legal document. They are intended as resources that can be selectively used and adapted with the advice of legal, medical and education resources to meet state, local and individual school district and specific departmental needs and requirements. All rights reserved. No part of this publication may be reproduced, stored in or introduced into a retrieval system now known or to be invented; transmitted in any form or by any means (electronic, mechanical, recording or otherwise); or used for advertising or promotional or educational purposes, general distribution, creating new collective works or for resale, without prior written permission of the copyright owner and publisher. Submit written requests to: Institute for Brain Potential, Permissions Department, 782 Vista Grande Avenue, Los Altos, CA 94024. To order additional copies or make any other queries, contact IBP Customer Service at: 650-960-3536 Library of Congress Cataloging-in-Publication Data Best Practices in the Behavioral Management of Chronic Disease: Volume IV: The Cost Effectiveness of Behavioral Health Interventions ISBN: 978-0-9832465-4-1 Library of Congress Control Number: 2016953253 Copyright © 2016 by Institute for Disease Management, a division of Institute for Brain Potential (IBP). Institute for Brain Potential (IBP) is a non-profit organization dedicated to providing advances in Behavioral Medicine through publications and conferences. IBP is a 501(c)(3) organization (tax identification number 77-0026830) founded in 1984 as Institute for Cortext Research and Development. The Institute has trained over one million health professionals in the neurobehavioral sciences and has published books in the fields of Neuropsychology and Behavioral Medicine including the three-volume series, Best Practices in the Behavioral Management of Chronic Disease. Printed in the United States of America BEST PRACTICES IN THE BEHAVIORAL MANAGEMENT OF CHRONIC DISEASE: VOLUME IV THE COST EFFECTIVENESS OF BEHAVIORAL HEALTH INTERVENTIONS Preface: UNDERSTANDING COST-EFFECTIVENESS RESEARCH 1 Recommendations for the General Reader 12 Glossary of Common Abbreviations in the Tables 19 PART 1: NEUROPSYCHIATRIC CONDITIONS Chapter 1: ANXIETY DISORDERS 22 Chapter 2: DEPRESSIVE DISORDERS 67 Supplement: GENERAL MENTAL HEALTH PROBLEMS 126 Chapter 3: BIPOLAR DISORDERS 136 Chapter 4: SCHIZOPHRENIC SPECTRUM DISORDERS 145 Chapter 5: PERSONALITY DISORDERS 164 Chapter 6: DELIBERATE SELF-HARM 181 Chapter 7: EATING DISORDERS 194 Chapter 8: ALCOHOL USE 208 Chapter 9: TOBACCO USE 233 Chapter 10: ILLICIT DRUG USE 250 Chapter 11: DISRUPTIVE BEHAVIOR DISORDERS IN YOUTH 267 PART 2: BEHAVIORAL MEDICINE Chapter 12: LIFESTYLE INTERVENTIONS FOR HEALTHY WEIGHT 287 Chapter 13: LIFESTYLE INTERVENTIONS FOR METABOLIC SYNDROME 309 Chapter 14: SLEEP DISORDERS 326 Chapter 15: CHRONIC SOMATIC SYMPTOMS 337 Chapter 16: CHRONIC PAIN 357 Chapter 17: DEMENTIA 388 Chapter 18: END-OF-LIFE CARE 402 Chapter 19: OTHER SELECTED MEDICAL DISORDERS 421 Epilogue: PROMISING HEALTHCARE DELIVERY SYSTEMS 436 5 Preface PREFACE: UNDERSTANDING COST-EFFECTIVENESS RESEARCH INTRODUCTION This unique text is designed as a practical guide for health care professionals and decision-makers who develop, implement or evaluate treatments that incorporate behavioral health interventions. This information can appear dense at first, but we hope this introduction will convince you why cost-effectiveness is so vital, and provide a comprehensible guide for how to interpret the findings summarized in this book. We strongly encourage all readers to read the section, “Recommendations for the General Reader” for handy tips on how to prioritize and digest the most relevant information for your specific needs. In the last decade, a revolution has occurred in the understanding and application of behavioral health for a wide spectrum of chronic conditions. Yet the majority of health care providers have not yet integrated behavioral interventions into their health care delivery systems. This text summarizes current knowledge from cost-effectiveness trials to reveal which behavioral health interventions can reduce costs and improve quality of life. To our knowledge, this text is the first of its kind to provide a systematic and detailed review of the economic benefits of behavioral health interventions. Increased life expectancy coupled with finite health care spending has made the cost-effective prevention and management of chronic conditions an urgent need. Individuals with one chronic condition incur double the health care costs of those with none. Multiple chronic conditions are increasingly common, exceeding 65% in the growing elderly population (65 years and older; Lehnert et al., 2011). In addition to significantly worse health outcomes, multiple chronic conditions also skyrocket costs: patients with multiple conditions cost up to seven times as much as those with only one chronic condition (Stanton et al., 2005). U.S. Health Care Spending The United States has the highest health care spending per capita of any developed country, without better health outcomes. Health care spending has risen from 9% of the U.S. economy in 1980 to 17.4% in 2013, now totaling almost $3 trillion. Some of this increased spending is due to aging of the population and a shift in medical focus from infectious to chronic disease. However, some is due to increased demand for and use of advanced technologies and newer prescription medications, where lower cost solutions could be similarly effective. Projections estimate that health care spending will continue to increase by an average of 5.7% per year, outpacing the estimated growth in GDP at 4.6%. At these rates, health care will total 19.3% of the U.S. economy by 2023 (Centers for Medicare and Medicaid Services, 2013).
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