What information is there on cost?

For people with severe mental illness, NICE guidelines cite possible net savings of £1,000 per person with schizophrenia treated with CBT, based on the first 18 months after initial treatment. This analysis only includes direct service costs and not any further savings to health and social care, to welfare through increased productivity and to criminal justice through reduced offending.

Early intervention for psychosis
The annual direct cost per patient of this type of service in terms of input from an early intervention team plus other community psychiatric services and inpatient care has been estimated at £10,927 at 2008/09 prices, considerably less than that of standard care at £16,704.

Assertive outreach services
The costs of intensive community care provided by assertive outreach teams and standard case management from community mental health teams for people who are high users of inpatient services and who have difficulties engaging with care, are similar.  Assertive outreach is associated with greater service user engagement and satisfaction with care, but in terms of cost-effectiveness, society would have to value satisfaction with care highly to recommend assertive outreach as the preferred approach for this group.

Medication costs
The differences in price between first and second generation antipsychotics has been reduced as many of the latter have become generic; nevertheless there is potential health gain and cost savings from review.

Drugs used in psychoses and related disorders (BNF 4.2)
Costs for this section have risen from 2010-2011 by £19.6m (6.8 per cent) with the number of items dispensed increasing by 0.4m (4.2 per cent). The increase in items dispensed is similar to that seen in the previous year.

Rising costs, rising volume

  • quetiapine, costs have risen by £10.9m (11.8 per cent), use has increased by 11.1 per cent.
  • olanzapine, costs have risen by £6.8m (6.0 per cent), use has increased by 4.3 per cent
  • aripiprazole, costs have risen by £6.7m (18.6 per cent), use has increased by 19.8 per cent.

Falling costs, rising volume with price reductions

  • risperidone, costs have fallen by £2.1m, (13.4 per cent) use has increased by 6.7 per cent.

Falling costs, falling volume and price reductions

  • amisulpride, costs have fallen by £2.7m (30.2 per cent), use has fallen by 2.9 per cent, mainly the 50mg tablets and liquid special formulations.
  • chlorpromazine hydrochloride, costs have fallen by £0.6m (30.2 per cent), use has fallen by 3.7 per cent.

Reasons cited for maintaining use of higher cost medications include tolerability, specific efficacy of tailored medication for the individual, dangers of destabilisation where change is for financial rather than clinical reasons28 98

‘Whatever it Takes’ services for integrated parents & child intervention (Fonagy – pers comm): estimated return on investment of £3 direct long-term cost saving for every £1 invested in. A headline Cost Benefit Analysis suggests that the direct and indirect societal cost saving is projected at £6 per £1 invested, providing a return on investment multiplier of 600%.

Rehabilitation and out-of-area placements
In 2009-10, 51% of total adult mental health and social care budget in UK(£6bn) was spent on services for people with longer term mental health problems. Half of this (25%) was spent on rehabilitation services and specialist mental health supported accommodation99

Out of area placements are expensive, costing, on average around 65% more than similar local services.  In 2008-9, out-of-area placements cost the NHS and social services around £330 million99 often with inadequate systems for monitoring the quality of care and the on-going need for the level of support provided100.