Value-Based Commissioning of Mental Health Services in England: A Feasibility Study Using Multicriteria Decision Analysis
Author(s)
Pamela Gongora-Salazar, DPhil1, Apostolos Tsiachristas, PhD2.
1Health, Nutrition and Population Division, Inter-American Development Bank, Washington DC, DC, USA, 2Associate Professor, University of Oxford, Oxford, United Kingdom.
1Health, Nutrition and Population Division, Inter-American Development Bank, Washington DC, DC, USA, 2Associate Professor, University of Oxford, Oxford, United Kingdom.
OBJECTIVES: Improving mental health services through value-based investment is high priority in health care systems globally. However, there is lack of comprehensive and robust evidence on the value-for-money of these services that incorporates several value elements and public preferences. This study aims to demonstrate the application of Multi-Criteria Decision Analysis (MCDA) in the assessment of two Early Intervention in Psychosis (EIP) services in England.
METHODS: An MCDA-based evaluation using patient records was conducted to evaluate the value-for-money of two EIP services in South-East England: Oxfordshire (EIP-Oxf) and Buckinghamshire (EIP-Bucks). The assessment considered five value-elements: years of life, quality of life (time to relapse), patient experience (disengagement rates), health inequality (time to relapse disparity), and average annual cost. Performance on each value-element was estimated using generalised linear models and propensity score matching on electronic health records of 1,127 patients. Total MCDA scores integrated standardised predicted means with relative weights derived in a previous study. Robustness was assessed using probabilistic sensitivity analysis and service affordability was illustrated in Conditional Multi-Attribute Acceptability Curves.
RESULTS: EIP-Oxf outperformed EIP-Bucks in overall scores (0.563 vs 0.552) and offered higher value per pound spend according to cost-per-value ratios (£10,438 per unit of value vs £12,655). Results were driven by lower annual cost per patient and health inequality in EIP-Oxf.
CONCLUSIONS: MCDA can facilitate value-for-money assessments of mental health services, addressing gaps in comprehensive rationing frameworks. This approach provides a systematic, evidence-driven method for local decision-making, with potential for broader healthcare applications.
METHODS: An MCDA-based evaluation using patient records was conducted to evaluate the value-for-money of two EIP services in South-East England: Oxfordshire (EIP-Oxf) and Buckinghamshire (EIP-Bucks). The assessment considered five value-elements: years of life, quality of life (time to relapse), patient experience (disengagement rates), health inequality (time to relapse disparity), and average annual cost. Performance on each value-element was estimated using generalised linear models and propensity score matching on electronic health records of 1,127 patients. Total MCDA scores integrated standardised predicted means with relative weights derived in a previous study. Robustness was assessed using probabilistic sensitivity analysis and service affordability was illustrated in Conditional Multi-Attribute Acceptability Curves.
RESULTS: EIP-Oxf outperformed EIP-Bucks in overall scores (0.563 vs 0.552) and offered higher value per pound spend according to cost-per-value ratios (£10,438 per unit of value vs £12,655). Results were driven by lower annual cost per patient and health inequality in EIP-Oxf.
CONCLUSIONS: MCDA can facilitate value-for-money assessments of mental health services, addressing gaps in comprehensive rationing frameworks. This approach provides a systematic, evidence-driven method for local decision-making, with potential for broader healthcare applications.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE748
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Mental Health (including addition), No Additional Disease & Conditions/Specialized Treatment Areas