Table 1 Economic evaluations alongside empirical studies for interventions promoting physical health for people with mental health problems

Barnett et al. 2008 [55]

I: Stepped smoking cessation programme (computer-assessments of quit readiness; 6 weeks psychological counselling, 10 weeks nicotine replacement therapy; bupropion,extra counselling.

322 cigarette smoking mental health out-patients aged 18+ with a diagnosis of unipolar depression

RCT

The mean costs of intervention were $346. Total mental health care costs in the intervention and control group were $4805 vs $4173. This difference was not significant.

The stepped care group had 5.5.% greater abstinence rate from smoking.(p-value <0.05)

Health care sector

Incremental cost per successful quit $11,496. Incremental cost per life year gained $9,580. Cost effective 74% of time if WTP per successful quit $40,000 .

USA

C: brief contact: information on quitting and list of cessation programmes from counsellor.

18 months

CEA

2003 US $

Chalder et al. 2012 [51]

I: Primary care facilitated physical activity plus usual primary care physician care

361 community dwelling individuals aged 18-69 with first or recent new episode of depression (>= 14 on BDI scale)

RCT

Mean health and social costs per participant in the intervention group were £39 greater, but this was not significant. The mean costs of the intervention for treatment completers were £252. Productivity losses were greater in the intervention group and this difference was almost significant at p=0.05 level

Significantly greater amount of physical activity at 12 months in intervention group Odds Ratio 2.27 p=0.0003.

Health care sector perspective only

Incremental cost per QALY gained of £20,834. 57% probability of being cost effective with WTP threshold of £30,000 per QALY gained. Not considered likely to be cost effective.

England, UK

Small but non significant QALY gain of 0.014.

C: Usual primary physician care only

12 months

CUA

2009 UK £

Craig et al. 2008 [58]

I: Integrated management of mental and substance abuse disorders by specially trained case managers in community mental health teams (CMHTs).

127 community dwelling mentally ill patients with comorbid substance use disorders treated by 40 specially trained and supervised case managers in CMHTs and105 community dwelling patients receiving usual case management from 39 case managers in CMHTs.

RCT

Total mean costs in the intervention and control groups were £18,672 and £17,639. This difference was not significant.

No impact on substance use levels between the groups at 18 month follow up, but small positive impact on mental health status

Health care and criminal justice sectors

No synthesis was reported as there was no significant difference in costs or substance abuse levels between the two groups.

UK

C: Standard case management in CMHTs

18 months

CCA

2004 UK £

Gusi et al. 2008 [49]

I: Primary care initiated supervised walks with a group in a park or forest tracks for 50 minutes, 3 times per week plus simple diet advice.

127 overweight, moderately obese or moderately depressed community dwelling older women.

RCT

The incremental cost of the exercise programme plus best care, relative to best care was €2250.

Body Mass Index (p<0.003)

Health care sector

Incremental cost per QALY gained: €311. 99.9% probability of being cost effective if WTP of just €600 per QALY gained.

Spain

Exercise: 29.7->29.4

Control: 30.6-> 30.8.

The mean incremental Quality Adjusted Life Years gained was 0.132 (95% CI:0.104-0.286)

C: The standard

6 months

CUA

2005 €

“best primary care” : routine care in general practice and a recommendation of exercise

Johnson-Masotti et al. 2000 [48]

Two interventions:

Community dwelling people with severe mental illness being treated on an outpatient basis at risk of HIV.

Modelling

The total costs of intervention include staff compensation, materials, transportation, overhead, and participants’ opportunity costs. Average cost per person:

Infection averted per 100 clients

Societal

Advocacy training group (A) was most cost effective for men with incremental cost per QALY gained of $48,585. For women single session intervention is cost saving

I: A multi-session small group intervention (M)

Men

USA

I: Advocacy training (multi-session that taught participants to act as safer sex advocates to their peers).(A)

Single session: $178

S: 0.041

Multi-session: $629

M: 0.087

Advocacy training: $786

A: 0.138

Women

S:0.098

M: -0.041

A: 0.019

QALY gains not documented

C: A single session, one-on-one HIV/AIDS education intervention (S)

3 months

CUA

1998 US $

Morse et al. 2006 [59]

Two interventions

149 homeless people treated on an outpatient basis having a wide range of severe mental illness with substance disorder (i.e. dual disorder diagnosis).

RCT

The mean total costs for the IACT ($48,764) and control group ($41,726) were significantly less than those for the ACTO group ($71,211) (p<0.05).

There were no differences between treatment groups in substance use.

Health care

Costs and outcomes were separately reported.

I: Integrated Assertive Community Treatment (IACT)

USA

I: Assertive Community Treatment Only (ACTO)

C: Standard care

24 months

CCA

2001 US $

Murphy et al 2012 (early online) [50]

I: 16 week tailored programme of exercise delivered in a leisure centre supervised by a qualified exercise professional. Plus subsequent 8 month telephone contact by exercise professional.

2,160 community dwelling sedentary individuals having coronary heart disease (CHD) risk, and/or mental health problems (mild anxiety, depression/ stress disorders)

RCT

Incremental cost for the mental health or mental health plus CHD group was £596 but this was not significant. There was a small significant improvement of 0.0058 QALYs gained in this group.

CHD group reported significantly higher levels of physical activity, but no difference for those referred wholly or partially for mental health reasons. The mental health group did have statistically significant improvement in depression/anxiety.

Public sector

Incremental cost per QALY gained for whole population £12,111. 89% probability of being cost effective at £30,000 per QALY gained. £10,276 per QALY gained for mental health or mental health and CHD group.

Wales, UK

C:Usual care plus information on benefits of exercise and location of local facilities

12 months

CUA

2009 UK £

Pinkerton et al. 2001 [47]

I: Small group HIV prevention programme in community mental health clinics, focusing on sexual communication, condom use skills, and motivation to practice safer sex.

87 community dwelling women at least being 18 years old with a psychiatric diagnosis of mental illness.

Modelling

Intervention cost per participant: $679. Saved $13,830 in HIV-related medical care costs. The cost per 100 women was $67,910, a net cost of $54,080 costs avoided in medical care costs. For sexually active women only, there were $22,284 in avoided medical care costs per 100 women.

For full sample, intervention averted 0.064 infections and saved 0.40 QALYs. For sexually active women only, 0.104 infections were averted and 0.64 QALYs saved.

Societal

For full sample, cost per QALY saved: $136,295.

USA

For sexually active women only, $71,367 per QALY saved.

C: Standard health promotion programme without inclusion of HIV

6 months

CUA

1999 US$

Rosenberg et al. 2004 [60]

I: Specialist brief programme delivered in community mental health centres to reduce risk of blood borne infectious disease.

173 community dwelling people with serious mental illness

A ‘before and after’ pilot study at one urban and one rural community mental health centre

Intervention costs per person ranged between $194 and $262.

Increased motivation to reduce risk behaviour such as HIV and hepatitis (p<0.01). But no actual decrease in self-reported risk behaviour.

Health care

Concluded that pilot study supports feasibility and efficacy of intervention.

USA

C: No controls – change in knowledge and risk behaviours post intervention

6 months

CCA

2002 US $

Rosenberg et al. 2010 [61]

I: Specialist brief programme delivered in community mental health centres to reduce risk of blood borne infectious disease

236 community dwelling people with severe mental illness and co-occurring substance use disorder largely from ethnic minority groups.

RCT

Intervention cost per person: $541 including $234 for blood tests.

People in the intervention group were more likely to be tested for HBV and HCV , and immunised against hepatitis A and hepatitis B, to reduce their substance abuse. However, they showed no decrease in risk behaviour.

Health care

Costs and outcomes were separately reported.

USA

C: Enhanced treatment as usual.

12 months

CCA

US $

Timko et al. 2006 [46]

I: Community residential facility acute support programme for dual disorder people

57 community dwelling and 173 hospital with dual psychiatric disorder and substance abuse diagnosis

RCT

Mean health care costs for the community group were $21,966 compared with $33,188 in the hospital group. This difference was not significant.

The community group had significantly improved Addiction Severity Index Scores compared to the hospital group. 26% of the community group were in remission compared with 16% of the hospital group. This was not significant

Health care

Costs and outcomes reported separately, but noted that mean costs for patients in remission in community group of $12,174 were less than half those of hospital group.

USA

C: Hospital inpatient acute support programme for dual disorder people

12 months

CCA

For those patients successfully in remission from substance abuse cost

2003 US$