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Am J Psychiatry 1997; 154:736-743
Copyright © 1997 by American Psychiatric Association
Getting the cost right in cost-effectiveness analyses
N Wolff, TW Helminiak and JK Tebes
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08903, USA. nwolff@rci.rutgers.edu
OBJECTIVE: The authors examined different ways of measuring unit costs and
how methodological assumptions can affect the magnitude of cost estimates
and the ratio of treatment costs in comparative studies of mental health
interventions. Four methodological choices may bias cost estimates: study
perspective, definition of the opportunity cost of resources, cost
allocation rules, and measurement of service units. METHOD: Unit costs for
outpatient services, individual therapy, and group therapy were calculated
under different assumptions for a single community mental health center
(CMHC). Using hypothetical service utilization profiles, the authors used
the unit costs to calculate the costs of mental health treatments provided
by two programs of the CMHC. RESULTS: The unit costs for an hour of
outpatient services ranged from $108 to $538. The unit costs for an hour of
therapy varied by 156%; unit costs were lowest if the management
perspective was assumed and highest if the economist perspective was
assumed. The ratio of the outpatient costs in the two treatment programs
ranged from 0.6 to 1.8. CONCLUSIONS: The potential errors introduced by
methodological choices can bias cost-effectiveness findings based on
randomized control trials. These errors go undetected because crucial
methodological information is not reported.
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