[Health economics of psychological diseases]

This article provides an overview of the characteristics and problems of the economic evaluation of mental health care. At first, the problems and methods of measuring direct and indirect costs of mental illness are discussed using cost of illness studies for depression and schizophrenia from the literature as examples. It is shown that, due to methodological problems of measuring costs of the wide range of mental health services as well as productivity losses, various cost of illness studies rendered very different results. Thereafter, the measurement of effects in the economic evaluation of mental health services is discussed whereby the problems of measuring quality-adjusted life years (QALYs) are addressed in particular. Despite the subjectivity of symptoms, preference-based valuation of health-related quality of life has rarely been attempted in psychiatric patients. Finally, frequent flaws of published cost-effectiveness analyses of mental health care are presented. These flaws make the interpretation and comparison of study results difficult. As there are hardly any German cost-effectiveness analyses of mental health care, more research efforts in this field seem to be necessary in Germany.