title: Economics of medically unexplained symptoms: a systematic review of the literature.
abstract: OBJECTIVE
  To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results.
  
  
  METHODS
  We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities.
  
  
  RESULTS
  We identified 5 COI and 8 EE, of which 6 were cost-minimization analyses and 2 were cost-effectiveness analyses. All studies used patient level data collected between 1980 and 2004 and were predominantly conducted in the USA (n = 10). COI found annual excess health care costs of somatizing patients between 432 and 5,353 USD in 2006 values. Indirect costs were estimated by only one EE and added up to about 18,000 USD per year. In EE, educational interventions for physicians as well as cognitive-behavioral therapy approaches for patients were evaluated. For both types of interventions, effectiveness was either shown within EE or by previous studies. Most EE found (often insignificant) cost reductions resulting from the interventions, but only two studies explicitly combined changes in costs with data on effectiveness to cost-effectiveness ratios (ratio of additional costs to additional effects).
  
  
  CONCLUSIONS
  Medically unexplained symptoms cause relevant annual excess costs in health care that are comparable to mental health problems like depression or anxiety disorders and which may be reduced by interventions targeting physicians as well as patients. More extensive research on indirect costs and cost-effectiveness is needed.
authors: Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. a.konnopka @ uke.de
authors: Alexander
authors: A
authors: Konnopka
authors: Rainer
authors: R
authors: Schaefert
authors: Sven
authors: S
authors: Heinrich
authors: Claudia
authors: C
authors: Kaufmann
authors: Melanie
authors: M
authors: Luppa
authors: Wolfgang
authors: W
authors: Herzog
authors: Hans-Helmut
authors: HH
authors: König
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D012107:Research Design; D013001:Somatoform Disorders / Q000191:economics* / Q000628:therapy