PATIENT VALUATION OF DIFFERENT APPROACHES TO MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT

Author(s)

Epstein AJ1, Barry CL2, Fiellin DA3, Busch SH3
1University of Pennsylvania, Philadelphia, PA, USA, 2Johns Hopkins University, Baltimore, MD, USA, 3Yale University, New Haven, CT, USA

OBJECTIVES: Treatment rates for mental health and substance use disorder (MH/SUD) conditions are low in the U.S.  We assessed consumers’ monetary valuation of primary care and collaborative care models for treating MH/SUD relative to usual care as a potential strategy for improving treatment rates. METHODS: We conducted a national, survey-embedded randomized vignette experiment of individuals with untreated MH/SUD in 2013.  58,928 adults were screened online and categorized as meeting criteria for either drug abuse (N=418) or alcohol abuse (N=698) based on DSM-IV criteria, or a mental health disorder based on a positive K6 score (N=1,030).  The 2,146 participants were randomized to view one of three treatment vignettes: usual care (N=726), primary care (N=697), or collaborative care (N=723).  Participants were asked whether they would be willing to enter treatment first if it were free to them, and then if they had to pay (for those initially indicating they were willing, randomly assigned as $10, $30 or $50) or were paid (for those initially indicating they were not willing, randomly assigned in $5 increments between $5 and $25).  Responses were aggregated to calculate, for each treatment approach, an inverse demand function (i.e., proportion of all participants willing to enter treatment at each price point).  After adjusting for MH/SUD condition, we fit linear regression lines through the inverse demand curves.  Participants’ average incremental value was calculated as the horizontal distance between the linearized inverse demand functions. RESULTS: Respondents valued primary care over usual care by $9.00 (95% confidence interval [CI]: $2.97, $15.04; p=0.003), and they valued collaborative care over usual care by $5.85 (95% CI: -$0.14, $11.85; p=0.056). CONCLUSIONS: Our results suggest that low treatment rates for MH/SUD may be addressed by increasing the availability of primary care and collaborative care treatment models, which are somewhat more appealing to consumers than usual care.

Conference/Value in Health Info

2015-05, ISPOR 2015, Philadelphia, PA, USA

Value in Health, Vol. 18, No. 3 (May 2015)

Code

PHS176

Topic

Health Policy & Regulatory

Topic Subcategory

Approval & Labeling

Disease

Mental Health

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