Managing finite resources
The public healthcare system is a system of infinite demand and finite resources. This is especially true for mental illnesses, where rising numbers of vulnerable individuals with chronic disorders require long-term financial commitment for their prolonged care. Tailored and context-specific solutions are the only way to drive down costs and achieve a sustainable, efficient equilibrium that can be carried by the public tax-payer.
One such context-specific solution is a new treatment being tested for care and management of patients with bipolar affective disorder. Preliminary data suggests that the new treatment is superior to the currently used one, in that patients recover from illness quicker and stay in recovery without relapsing for longer. There is debate how much money the new treatment will cost and if those costs are justified. The current dashboard summarizes the findings of a cost-benefit analysis.
New treatment superiority
Before considering the costs, first an overview of the evidence supporting the superiority of the new treatment is presented here. A randomized control trial has been conducted with 3,000 bipolar outpatients receiving the new care strategy and 3,000 receiving treatment as usual. Patients were matched on their symptom severity in that they were all at the start of their disease (i.e in a healthy state) and were followed throughout the years to see how many will fall ill and later recover from their illness.
In the graph we see that as early as 5 years in public health benefits can already be seen in that less patients became severely ill (in light purple). Many more patients recovered throughout the years and remained in recovery (green). Although this is a single trial, the evidence is promising that the benefits of implementing the new strategy could be substantial.
The point of cost domination
While the new strategy has been shown to be of public health benefit, the costs of implementing it per patient have not yet been fixed. Some groups claim it is possible to implement the new strategy for as little as £1,000 per patient per year extra, others cite costs as high as £4,000 per year. We need to remember that if the treatment is very effictive, the costs of patient care will be offset by the savings of a healthy population.
With so much uncertainty in price, a simulation study was conducted to investigate how different prices of the new strategy could ultimately affect the tax payer. The graph on the right summar*izes the results and shows that only if the new care is more expensive than £2,800 pounds per year will the costs offset the societal benefits of updating the currents strategy.
Making decisions under uncertainty
The rising costs of healthcare, especially within the domain of mental health, are pressing the need for sustainable and efficient innovation. In the analysis so far we introduced a novel strategy for care and support of patients with bipolar mood disorder. We demonstrated that it is of public health benefit using data from a large scale randomized control trial. Then, we plugged the information from that trial and uncertain information about the costs to come up with a zone where the new strategy is preferred over the current one.
In the current case we found that the costs outweigh the benefits after the £2,800 mark. If the new strategy costs less than £2,800, it should be implemented unequivocally. If the new strategy ends up costing more than that, a public discussion should be had about about finance priorities. The procedure thus allows us to take the data we have on hand, evaluate it for how informative it is to make a decision, and make a decision acknowledging the uncertainty around the information we have. This is the essence of data-driven decision making, applicable to any problem where costs and benefits are at play.
