• cost-effectiveness analysis;
  • equity;
  • resource allocation;
  • schizophrenia;
  • societal preference

Objective:  Recent generalized cost-effectiveness analyses contrasting schizophrenia with high prevalence mental disorders have noted a need to investigate the mechanisms by which the tensions between equity and efficiency can be reconciled and inform priority setting in resource allocation. This paper explores and illustrates some possible strategies for valuing mental health states, with the broad goal of improving resource allocation decisions.

Method:  Health utility gains derived for current and optimal treatments for schizophrenia, depression and anxiety disorders, potential societal preference weightings, and annual costs per treated case, are used to illustrate the magnitude of the impacts on relative cost-efficiency and societal welfare estimates. These estimates are based on costs per additional quality adjusted life year (QALY) and costs per additional S-QALY (i.e. QALYs adjusted for societal value of health gains) respectively.

Results:  When broader societal preferences are ignored, current and optimal treatments for depression and anxiety are around 10 times more efficient than those for schizophrenia, but treatments for all three disorders appear to give rise to similar levels of societal welfare when weighting factors reflecting equity concerns are incorporated.

Conclusions:  There is manifest inequality in health between individuals with schizophrenia and those with high prevalence mental disorders, even with optimal treatment. Schizophrenia is much more costly to treat but other factors require consideration. Inclusion of societal preferences should lead to more rational decision-making and improved societal welfare. In turn, greater effort needs to be given to the development and validation of appropriate weighting factors reflecting distributive preferences in mental health.