Improving integrated care for mental and physical comorbidities through better European evidence

Abstract Introduction Mental health problems are prevalent, enduring with decreased life expectancy, mostly due to comorbid physical conditions. This calls for more tailored policy considerations toward integrated care options and better supporting evidence. Methods We conducted a European evidence synthesis and modelling project to assess the physical health burden and related cost consequences of alcohol-use disorders, bipolar disorder, depression and schizophrenia for working-age adults in 32 countries. We synthesized existing health economic literature for excess cost ranges associated with physical comorbidities for different care segments and productivity losses, developed meta-analyzed estimates of relative prevalence risks of physical health conditions for individual mental disorders, and modelled associated population-level physical health burdens. Finally, using harmonized methods, we modelled associated annual physical hospital care and productivity loss costs across ICD-10 chapters at country level. Results Synthesis of 110 studies showed diverse excess physical health care costs across healthcare segments and health conditions (37-110%). Based on 41 eligible studies, relative prevalence risk of comorbid physical health conditions ranged from 0.81 (schizophrenia) to 3.66 (bipolar disorder). Across Europe, excess annual population-level comorbid physical health burden was between 84 million (alcohol use disorders) and 5 million cases (schizophrenia) resulting in hospital costs between 14 billion (depression) and 0.6 billion PPS€ (schizophrenia), and lost productivity costs of 37 billion (depression) and 0.6 billion PPS€ (schizophrenia). Conclusions Population-level physical comorbidity cost evidence is greatly influenced by the underlying mental disorder prevalence. While alcohol use disorder and depression may elicit the highest total excess, proportional excess is greatest for bipolar disorder. Schizophrenia estimates are impacted by low access, employment and age. Key messages • New European evidence supports major potential cost savings linked to better physical health through improved integrated care of mental and physical disorders. • Policy makers have to take into consideration existing data limitations and the need for differential interpretation of total vs. proportional excess information.