The cost of mental disorders in France

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Abstract

Aims: To provide burden estimates of mental disorders in France and compare the results with findings from other countries and EU in general.

Method: Stepwise top down approach, consisting of analyses of existing data sets, national surveys and ad hoc surveys. Mental disorder was defined by diagnoses in the chapter ‘Mental and behavioural disorders’ from the International Classification of Diseases, tenth revision (ICD-10), excluding, dementia and mental retardation. Disease burden was measured by total health care costs, social care costs, lost output and loss of well being, 2007 data was used consistently.

Results: The total cost of mental health care was estimated at €13.4 billion, or 8% of total healthcare expenditures. Total cost of health and social services was estimated at €6.3 billion, including €1.3 billion for informal care. Total cost of lost production amounted to €24.4 billion, €20.0 billion for lost output and €4.4 billion for workers' compensation. Mental disorders resulted in a total loss of 2.2 million QALY and a total cost of lost well being of €65.08 billion. The total costs of mental disorders were estimated at €109 billion, 20% of which are actual money spent and 80% the social value of disease consequences.

Conclusion: In France with a population of 65 million, an estimated 12 million inhabitants currently suffer from one or more mental disorders. The true size and burden of mental disorders in France was significantly underestimated by policy makers in the past.

Introduction

While the costs of brain disorders in Europe are documented on a regular basis (on behalf of the CDBE2010 study group the European Brain Council, CDBE2010 Study Group, Wittchen et al., 2011), information on the costs of mental disorders per se is scarce. The production of country specific information has been considered by the authors of the report on brain disorders as a mean to influence national and EU policy (Wittchen et al., 2011) and draw attention to the high burden that mental disorders impose on individuals, families, healthcare systems and societies (The Sainsbury Centre for Mental Health, 2003). To the best of our knowledge, few data were available for France. Our objective was to estimate the cost of mental disorders in France including health and social care, lost production and loss of well being.

Section snippets

Material and method

The costs of mental illness for France in 2007 were estimated from a societal perspective and broken down into four categories: direct health care costs, direct non-medical costs including social care, indirect costs i.e. lost production due to work absence or early retirement and of quality of life losses (The Sainsbury Centre for Mental Health, 2003). Mental illness was defined by diagnoses in the chapter ‘Mental and behavioural disorders’ from the International Classification of Diseases,

Direct health care costs

The total cost of mental health care was estimated at €13.4 billion, including €0.4 billion for psychologist consultation costs. In-patient costs amounted to €8.3 billion, accounting for 64% of total healthcare costs for mental disorders. The most significant expense item was care provided in public psychiatric hospitals (€6.4 billion). Out of hospital costs were valued at €4.7 billion, encompassing €2.2 billion for drug prescriptions, €1.0 billion for private consultations, €1.0 billion for

Discussion

In France with a population of 65 million, an estimated 12 million inhabitants (18%) currently suffer from one or more mental disorders (Missions et organisation de la santé mentale et de la psychiatrie, 2009). On the basis of our classification of the burden associated with mental disorders in France, we found that the total cost amounted to 109 billion Euros in 2007 including health and social care costs, productivity losses and intangible costs. Direct healthcare costs totalled €13.4

Limitations

We chose a top down rather than a prevalence-based bottom up approach. Both methods have been undertaken but the largest international studies have relied on the bottom-up approach using prevalence data. We chose the top down approach as more convincing to policy makers who deal with public accounts and who are interested in the burden by payer (Social Health Insurance, State, communities, employers, individuals) and mot by disease. A more scientific rationale was that a top down approach

Role of funding source

This work was supported by the Assistance Publique des Hôpitaux de Paris (AP-HP), INSERM (U955), AVIESAN (ITMO Neurosciences), Réseau Thématique de Recherche et de Soins en Santé Mentale (Fondation FondaMental®) (Grant to AP-HP).

Contributors

Karine Chevreul, Marion Leboyer and Isabelle Durand-Zaleski designed the study and wrote the protocol. Amélie Prigent and Aurélie Bourmaud collected data from the relevant sources and undertook the valuation, Amélie Prigent and Isabelle Durand-Zaleski wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript

Conflict of interest

None of the authors have conflicts of interest associated with the work reported in this paper.

Acknowledgements

We are indebted to Ms. Karen Brigham, who kindly assisted with proof-reading of the manuscript and to Ms. Marie Gunullu for editorial assistance. This work benefited from the valuable inputs of the following institutions and individuals: Institut de Recherche et Documentation en Economie de la Santé (IRDES): Ms. Catherine Sermet, Mr. Thomas Renaud HEVA: Mr. Alexandre Vainchtok Ministry of Health, Directorate of Research, studies, evaluation and Statistics: Mr. Alexandre Bourgeois, Mr. Michel

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