May 12, 2014

by Lesley Curtis

How much will it cost?  Can you prove that your idea is cost-effective?  How are you performing?  Is that value-for-money?

These are just some of the questions that commissioners of services across all sectors are constantly asked.  But fundamental to successfully answering these questions is knowing the “unit cost” of their service, and crucially, trusting the robustness and accuracy of this unit cost.

For more than 20 years, the Personal Social Services Research Unit (PSSRU) at Kent and LSE has been pioneering approaches for estimating the costs of health and social care services. The latest 2013 edition of the Unit Costs report is the 21st edition to be published, providing data for over one hundred health and social care services.

Many academics and practitioners are using our unit costs information. The citation counts in Google Scholar/Web of Science show that our unit cost publication has been cited in 68% of economic evaluations which took place in England between 2008 and 2013. We want this figure to continue to rise and we are determined that many more benefit from this resource. We also want many more service commissioners and practitioners to use our work. So through the examples given in this blog, and in others to come, we want to inspire many more to use the wealth of information we provide.

For the remainder of this blog we are going to focus on mental health services. Mental Health service provision is extremely costly. There is a growing body of research examining the most cost-effective ways of meeting this need, and our high quality unit cost information is at the heart of this research.

Treating Psychosis

In April 2014, Rethink Mental Illness, a charity working with people affected by mental illness for 40 years, published important new research undertaken by PSSRU staff at LSE. Key to this research was accurate and current unit cost information which has enabled them to offer “up-to-date evidence about the most effective services for treating psychosis, both in terms of helping people recover, and giving commissioners the best value for money.” Through these costings, the researchers were able to conclude that “there is a strong business case for investing in the early intervention and community-based interventions proven to generate savings or value-for-money gains through reduced inpatient admission, or through other routes.”

Dementia at End of Life

There is limited evidence on the quality, quantity or cost of support for people with dementia at their end-of-life outside of acute settings. Recent research, that included PSSRU colleagues, seeks to address this issue. Through the use of our unit cost information, the researchers have sort to evaluate the economic case for an intervention designed to improve end-of-life care for older people with dementia in care homes. They conclude that “the intervention was perceived as having a positive impact on working relationships between care homes and visiting health care practitioners. Following the intervention total service costs fell by 43%. Hospital care costs fell by 88%…but more research is needed to test these findings further with larger samples and more robust controls.”

Carers Coping with Dementia of Family Members

Our unit cost data has been pivotal in examining the cost-effectiveness of a coping strategy programme promoting the mental health of family carers of people with dementia. Findings from the recently published article in the British Medical Journal demonstrated that this was indeed a highly cost-effective addition to the services typically offered, in terms of the carers own health and quality of life.

Cognitive Behaviour Therapy for Depression Treatment

Cognitive Behaviour Therapy (CBT) is increasingly being used as a treatment for depression and a number of recent articles have examined its cost-effectiveness. A recent publication involving PSSRU staff demonstrated the value-for-money of CBT insomnia workshops. Another piece assessed the effectiveness and cost-effectiveness of 1-day CBT self-confidence workshops in reducing depression and concluded that these workshops “appear promising in terms of clinical effectiveness, cost-effectiveness and access by difficult-to-engage groups.” Again, the building blocks for this costings analysis has been the unit costs that we provide. In recognition of the increasing use of CBT for treating depression, a piece by Barbara Barrett and Hristina Petkova appears within the editorials of our 2013 Unit Cost report.

Mental Health Conditions in Children

Far less research exists for mental health illnesses for children than adults. Studies by PSSRU look to redress this imbalance.  Recently published work by PSSRU examines the fact that although childhood hyperactivity and conduct problems are associated with difficulties in adulthood, little is known about later service use or public expenditure costs in the UK. Drawing on our unit cost information, colleagues were able to demonstrate that “high levels of childhood conduct problems were associated with a two- to threefold increase in early adulthood costs, mainly driven by criminal justice contacts.”

Preventonomics

Our unit costs are a key driver behind the exciting new Preventonomics work that PSSRU at LSE are undertaking, as part of The Big Lottery Fund’s Fulfilling Lives: A Better Start initiative. Their blog highlights that “there is a general consensus that not enough is invested in prevention and early intervention [within childrens’ services]…Shifting money into preventative services means an increase in expenditure in the short term, but financial pay-offs may not happen until the medium- to longer-term. Moreover, expenditure on prevention from one budget may lead to savings in another; perhaps higher health care costs today reduce use of additional education supports when children are older. Preventonomics’ is about finding evidence of the costs associated with not implementing preventative interventions, identifying cost-effective interventions and estimating potential savings from preventative interventions.”

The Unit Cost Report and You

These examples are just a flavour of where our unit cost report has impacted. Where will it be able to help you?

Perhaps you are involved in health and social care service provision and can now draw upon our work. Many commissioners and procurement departments already have.

One testified that “the information provided in this document is invaluable and has helped us significantly in the work we have carried out for clients in the area of health and social care…It is in my opinion a terrific reference material, easily understood and a great example of how high class academic research helps in so many ways.”

How You Can Contribute

The Unit Cost report is a dynamic and ever-evolving document that benefits greatly from the contributions of health and social care staff.

If you would like to contribute to the Unit Costs of Health and Social Care publication, here are some ways to get involved:

• Are you a health and social care professional? We would like to know how you spend your time! You can participate in our research by following this link: https://www.surveymonkey.com/s/SZMF5YL
• If you have cost information for new services or sources of information for any element of the unit costs (e.g. new overhead or qualification information), we would love to hear from you.
• Suggestions are welcome for short articles and guest editorials.
• Any comments or information you would like to send us can be submitted using our online feedback form.

Further Information:

For details on why unit costs are needed and how we calculate them, please see the previous blog post.

Point Of Contact:

For more information on the Unit Costs of Health and Social Care, please contact Lesley Curtis (L.A.Curtis@kent.ac.uk)