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As an elf economist, research on obsessive-compulsive disorder (OCD) doesn’t often get my attention. As authors of a recent paper in Integrative Psychiatry Point out that there is very little economic evidence about OCD. Indeed, a quick search of PubMed finds only 5 papers tagged with MeSH terms in 2023. OCD And EconomicsPrevalence estimates of OCD may be as high as 3%.
OCD is characterized by repetitive, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) that a person is driven to perform. These behaviors and thoughts can significantly interfere with daily activities and cause distress.
In the UK, OCD treatment follows a ‘stepped-care’ model, with cognitive behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs; to learn more, read Alan Underwood’s 2016 Mental Elf blog). But inpatient care is also necessary, costing the health service much more.
Understanding more about the cost of illness for OCD can help guide the allocation of resources to research and care. Also, Kochar and colleagues (2023) conducted a Cost of Illness (CoI) study seeking to estimate the economic burden of OCD over one year in the UK.
OCD ranks in the top 10 for global neuropsychiatric disability burden, yet little is known about the economic cost of OCD to individuals or society.
methods
To estimate the total cost of illness for the UK, the researchers modeled children, adults and older people with OCD separately, applying different levels of prevalence and severity and identifying different treatment options for these groups. Prevalence and severity estimates were derived from publicly available national surveys and published studies on the distribution of severity within each group. The research is described as using a ‘bottom-up’ approach, meaning that individual cost components are added together rather than an estimate of total cost.
Costs were estimated separately for different sub-populations. In addition to the unit costs of NHS treatments, out-of-pocket costs and private therapy costs were considered, as was the value of lost productivity due to reduced work capacity. Some of the inputs were based on expert opinion and the researchers judiciously relegated these to scenario analysis.
Results
The annual cost of OCD in the UK from a care provider perspective is estimated at £378 million. That’s £525 for a person with OCD.
When social costs such as lost productivity, out-of-pocket costs and private therapy are included, CoI rose dramatically to £5 billion, with an average of £7,077 per person with OCD, This social expenditure constitutes 92% of the total CoI, emphasizing the significant economic impact beyond health care costs. Lost productivity alone – which is measured for adults only – is worth £4,797 per person, or £3.5 billion per population. On average, patients are estimated to spend £1,400 a year on private treatment.
Age-wise cost analysis showed Adults bear the entire health care costBecause of the high prevalence of OCD, however The average cost of childcare was higher (£651) due to more regular provision of expensive treatments. Like CBT. Severity of OCD also affected care costs, with severe cases generating higher costs on average: £902 for those with severe OCD and £174 for those with mild OCD symptoms.
Treatment-wise, SSRIs are cheaper at around £48 per patient, compared with care costs of £1,417 per person receiving CBT. At the other end of the scale, patients receiving inpatient care receive an average of £8,658 a year.
Scenario analyzes and sensitivity analyzes revealed that comorbid depression doubled the estimated cost to the health service, and a similar effect was found when presenteeism and caregiver productivity losses were accounted for.
The annual cost of OCD in the UK (including personal costs) is estimated to be over £5 billion, which is approximately £7,077 per person with OCD. On average, patients spend £1,400 a year on private treatment.
Conclusions
- Despite relatively little research into its economic impact, it is estimated that health and care services in the UK spend around £378 million caring for people with OCD.
- When the wider societal costs are taken into account, the cost of the illness reaches £5 billion, or £7,077 per person with OCD.
- Research suggests that patients and wider society bear more of the cost than the NHS,
OCD reduces productivity by absenteeism, presenteeism (working less effectively) and caregivers cutting their hours; This cost is estimated to exceed the cost of healthcare services such as the NHS.
Strengths and limitations
The authors take a relatively conservative approach, which I find strong. They focus their base case analysis on inputs that have some degree of confidence., estimates of prevalence and health care costs. This means we can consider their headline estimate £378 million Relatively strong lower limits for costs related to OCD in the UK,
Another strength of the study It breaks down expectations by age and severityThis not only makes the results more informative but also makes it easier for readers to grasp the results.
A major limitation of the study was the reliance on expert opinion for analyzes beyond the base case, and The authors do not do a good job of explaining how they went about obtaining these expert opinionswe do not know whether they used an identified and validated framework, and the results obtained from these inputs (eg, related to comorbid depression and private therapy) cannot be considered robust.
Although the authors adopt a relatively conservative approach to estimating economic cost (increasing robustness), they are ambiguous about relying on expert opinions in analyzes (decreasing robustness). Clear reporting of methods is important in determining reliability and validity.
Implications for practice
Cost-of-illness studies produce large numbers that are difficult to interpret in isolation. Over the years, we’ve written about similar studies of bipolar disorder, perinatal mental health problems, multimorbidity, and perhaps others. So what should we read into these numbers?
Well, the authors make some comparisons with other mental health conditions, noting that the cost is lower than the costs cited for depression, but higher than anorexia. personally, I treat such comparisons with great caution, since an important determinant of differences may be methodological choices.such as the time horizon, inclusion and exclusion of different cost categories, and procedures for stratifying the population.
Studies like these are particularly useful in that they facilitate within-study comparisons., for example, at more than £1,700 per person per year, the cost burden associated with private therapy and out-of-pocket costs is surprisingly high, especially compared to the £525 per person cost to the NHS. The evidence here is weak, based on expert opinion, so it cannot be accepted at face value, but it does highlight an important area for future research. Further studies could investigate the frequency with which different groups of people with OCD access private treatment, how much it costs them, and its impact on their lives.
Overall, this study makes a good case For the significance of the economic burden of OCD in the UKAnd the findings should inform future strategies for investments in related research and care for people with OCD.
This study suggests a need for more research to understand the economic burden of OCD, particularly on the individual and caregivers.
Declaration of Interests
There is none.
Links
Primary paper
Kochar, N., Ip, S., Vardanega, V., Ciro, NT, & Feinberg, NA (2023). A cost-of-illness analysis of the economic burden of obsessive-compulsive disorder in the United Kingdom. Integrative Psychiatry, 127,152422.
Other references
Sampson, C. (2015). Postnatal mental health problems cost the UK £8 billion a year? The Mental Elf.
Sampson, C. (2015). Searching for the cost of bipolar disorderThe Mental Elf.
Saunders, K., & Vereeken, S. (2023). Health care cost of multimorbidity among people with mental health diagnoses in DenmarkThe Mental Elf.
Underwood, A. (2016). Antidepressants and psychotherapy for OCD in adults: a network meta-analysisThe Mental Elf.