Abstract
Background: In Greece, the provision of mental health services is limited to people residing in rural and remote areas. The operation of Mobile Mental Health Units (MMHUs) has been introduced in the Cyclades islands. It is an innovative policy intervention that has been shown to be effective and efficient internationally. Objective: The aim was to evaluate the operation of MMHUs in the Cyclades islands based on real-world evidence (RWE), from a societal perspective. Methods: A cost-effectiveness analysis was performed where outcomes and costs were elaborated and classified based on two comparators, 1) with MMHUs’ operation and 2) without MMHUs’ operation. Clinical primary outcomes were based on RWE data and were elaborated for the Disability-Adjusted Life Years (DALYs) values calculation, for a 12 months’ time horizon. Data descriptive statistics were performed with SPSS Statistics 22.0. Direct medical, non-medical and indirect costs were incorporated. Unit costs and monetary values were extracted from published data. Sensitivity analysis was undertaken to test the robustness of the results. Results: The operation of MMHUs in the Cyclades islands led to an incremental cost of €12,250.78 per DALY averted. A substantial higher increase is observed in the direct non-medical costs of the non-MMHUs’ operation where patients had to pay approximately €2,602 per capita annually for their transportation and accommodation due to hospitalization and outpatient care. Informal care expenses are 3 fold increasing in the non-MMHUs’ operation arm. Both direct non-medical and informal care costs correspond to high out of pocket payments totally covered by the patients. The sensitivity analyses demonstrated that the decision does not change when we varied the unit costs by ±10%. Conclusions: The operation of MMHUs appears to be a cost-effective option for treating patients with mental disorders in remote areas and islands in Greece. MMHUs appear to overcome the existing NHS structural inefficiencies by minimizing public expenditures and patients’ income losses by preventing and improving their mental health status.
Highlights
The burden of illnesses from mental health disorders is by far the highest of all health problems worldwide, ranging from 10% to 13% of the total burden of illness from all diseases and accounting for 32.4% of years lost due to mental illness or disability (YLDs) and 13% of Disability-Adjusted Life Years (DALYs) [1] [2] [3].In Greece, the provision of mental health is limited to people residing in rural and remote areas the universal and free access to health care constitutes fundamental principles of the National Health System (ESY) since its establishment in 1983
The operation of Mobile Mental Health Units (MMHUs) in the Cyclades islands led to an incremental cost of €12,250.78 per DALY averted
The operation of MMHUs is mainly aimed at the provision of primary mental health services, and workshops, educational seminars to health professionals, teachers and other professional groups e.g. police officers, have been organized so as to be able to identify, manage and refer people in need for mental health care [17]
Summary
In Greece, the provision of mental health is limited to people residing in rural and remote areas the universal and free access to health care constitutes fundamental principles of the National Health System (ESY) since its establishment in 1983. This has been discussed and characterized as a major public health problem with marked consequences for society [4] [5] [6]. Conclusions: The operation of MMHUs appears to be a cost-effective option for treating patients with mental disorders in remote areas and islands
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