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Making the economic case for tackling somatoform disorders

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Background/Objectives: Studies have suggested that as many as 26% of all primary care consultations may be attributed to medically unexplained symptoms (MUS). These somatoform disorders have previously been estimated to cost the health care system in England alone £ 3 billion per annum. Our objective therefore was to estimate the potential economic case for investing in measures to tackle medically unexplained symptoms in primary care in England. Methods: A rapid literature review was conducted to search for the evidence on economic evaluations and effectiveness studies of interventions to identify and help people with tackle medically unexplained symptoms. Databases searched included Medline, EMBASE, PsychINFO, the Cochrane Library and the NHS Economic Evaluation Database. Following this review a two year decision analytical model, synthesising data on effects and costs, was constructed to examine the cost-effectiveness of interventions, identified as being effective in helping to prevent a long duration of MUS. Sensitivity analysis would then be run to test the robustness of model study results. Results: Our review indicated that the most cost effective intervention appeared to be cognitive behavioural therapy. We assumed that a course of CBT would consist of ten 50 minute sessions at a conservative cost of £ 400. Following the completion of therapy at 30 weeks, the model predicted that the costs of CBT began to be offset by a reduction in the likelihood that individuals would seek help with apparent physical health problems. By the end of the second year, there were significant net cost savings not only for the English NHS, but also to the economy as a whole as a result of a reduction in time out of work, as well as improvements in quality of life due to a reduction in pain and discomfort. Discussion/Conclusions: The alleviation of MUS and improved mental and physical wellbeing potentially is a highly cost effective intervention. A reduction in consultations that arise because of MUS will free up primary care physician time for other activities. The extent to which CBT can be cost-effective crucially depends on the willingness of people with somatoform disorders to agree to participate in CBT therapy. One option to explore further is the use of computerised CBT. This would allow individuals to complete CBT sessions at a time and location of their choosing, which might be perceived as being less stigmatising.

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