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Cost-benefit of IAPT Norway and effects on work-related outcomes and health care utilization: results from a
Otto R F Smith1,2,3, David M Clark4, Gunnel Hensing5
1Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.
Background:
Data from an RCT of IAPT Norway ("Prompt Mental Health Care" [PMHC]) were linked to several administrative registers up to five years following the intervention. The aims were to (1) examine the effects of PMHC compared to treatment-as-usual (TAU) on work-related outcomes and health care use, (2) estimate the cost-benefit of PMHC, and (3) examine whether clinical outcomes at six-month follow-up explained the effects of PMHC on work-/cost-benefit-related outcomes.
Methods:
RCTs with parallel assignment were conducted at two PMHC sites (N = 738) during 2016/2017. Eligible participants were considered for admission due to anxiety and/or depression. We used Bayesian estimation with 90% credibility intervals (CI) and posterior probabilities (PP) of effects in favor of PMHC. Primary outcome years were 2018-2022. The cost-benefit analysis estimated the overall economic gain expressed in terms of a benefit-cost ratio and the differences in overall public sector spending.
Results:
The PMHC group was more likely than the TAU group to be in regular work without receiving welfare benefits in 2019-2022 (1.27 ≤ OR ≤ 1.43). Some evidence was found that the PMHC group spent less on health care. The benefit-cost ratio in terms of economic gain relative to intervention costs was estimated at 5.26 (90%CI - 1.28, 11.8). The PP of PMHC being cost-beneficial for the economy as a whole was 85.9%. The estimated difference in public sector spending was small. PMHC effects on work participation and cost-benefit were largely explained by PMHC effects on mental health.
Conclusions:
The results support the societal economic benefit of investing in IAPT-like services.
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