Assessing Cost-Effectiveness--Mental Health: introduction to the study and methods.
OBJECTIVE
The Assessing Cost-Effectiveness - Mental Health (ACE-MH) study aims to assess from a health sector perspective, whether there are options for change that could improve the effectiveness and efficiency of Australia's current mental health services by directing available resources toward "best practice" cost-effective services.


METHODS
The use of standardized evaluation methods addresses the reservations expressed by many economists about the simplistic use of League Tables based on economic studies confounded by differences in methods, context and setting. The cost-effectiveness ratio for each intervention is calculated using economic and epidemiological data. This includes systematic reviews and randomised controlled trials for efficacy, the Australian Surveys of Mental Health and Wellbeing for current practice and a combination of trials and longitudinal studies for adherence. The cost-effectiveness ratios are presented as cost (A$) per disability-adjusted life year (DALY) saved with a 95% uncertainty interval based on Monte Carlo simulation modelling. An assessment of interventions on "second filter" criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") allows broader concepts of 'benefit' to be taken into account, as well as factors that might influence policy judgements in addition to cost-effectiveness ratios.


CONCLUSIONS
The main limitation of the study is in the translation of the effect size from trials into a change in the DALY disability weight, which required the use of newly developed methods. While comparisons within disorders are valid, comparisons across disorders should be made with caution. A series of articles is planned to present the results.
Health Surveillance and Evaluation Section, Public Health, Department of Human Services, Melbourne, Australia. michelle.haby@dhs.vic.gov.au
Michelle M
MM
Haby
Rob
R
Carter
Cathrine
C
Mihalopoulos
Anne
A
Magnus
Kristy
K
Sanderson
Gavin
G
Andrews
Theo
T
Vos
D001008:Anxiety Disorders / Q000191:economics* / Q000628:therapy; D001315:Australia; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy; D006291:Health Policy; D006801:Humans; D008605:Mental Health Services / Q000191:economics*; D009010:Monte Carlo Method; D012559:Schizophrenia / Q000191:economics* / Q000628:therapy