Like a well-known cosmetic advert, this book makes psychotherapy beautiful: a book that proves we are worth it! As in all slogans there is some truth mixed with spin.
The book is divided by diagnosis and most chapters follow a logical format. Why is the condition important? For example, Rosenblatt states that anxiety disorders are ‘one of the most expensive disorders’, accounting for 31% of mental health costs at US$46.6 billion in one year. This makes a compelling argument that mental health desperately needs cost-effectiveness studies. But there is too little on the quality criteria for health economics papers to allow readers to critique the studies effectively.
The methodology is basically a simple search strategy plus literature reviews. Here is where the promise is more than the reality: the authors simply use ‘cost’ as a principal search term and produce lots of studies about the overall costs of disorders with estimates of cost reduction. There are very few studies using established methodologies to assess cost-effectiveness. The best studies are summarised with tables to allow comparisons.
The sting is often in the tail, for example in the conclusions to the anxiety chapter:
Although there are increasing data that specifically measure the cost-effectiveness of psychotherapy for the anxiety disorders, a strong case can be made … simply by considering the available data documenting the high costs of these illnesses and data indicating the cost of effective treatment. (p. 116)
Given the book's subtitle, such an inexhaustive approach is disappointing but perhaps inevitable as we know already there are not enough health economics studies to fill a whole book. Nevertheless, this is a good compendium of research and is generally up to date. The discussions have a strong US bias, but unlike many books of this type there is a reasonable coverage of non-American studies. The emphasis on diagnosis, however, limits the book too much, although a good chapter on medical conditions mitigates this.
For anyone trying to convince service commissioners that non-drug treatments are effective this book is invaluable. It argues cogently that psychotherapy can be cost-effective, but that is a big step from saying that it always will be, as cost-effectiveness depends crucially on how a service is delivered.
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