Value of Treatment – Policy White Paper
Executive Summary of the Value of Treatment White Paper
The vision is clear: mental and neurological disorders, or “disorders of the brain” are complex and interlinked with hundreds of specific diagnoses, codified in diagnostic classifications systems (currently under revision WHO International Classification of Diseases, ICD-11 and American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, DSM-V). Until recently, brain disorders were associated with disciplinary fragmentation in research and practice, using different concepts and approaches. There is today greater awareness on their common denominators, burden and challenges to manage them in a more integrated approach, and even to prevent some of them.
Brain disorders are becoming more prevalent over time and are threatening not only the quality of life of millions of European citizens but are also creating major challenges for the EU’s capacity to achieve the goals of its Europe 2020 strategy on economic growth and job recovery.
Budgetary restrictions across the EU are threatening the sustainability of the European social welfare model as a whole, and make it even more important to achieve cost-effectiveness in the use of resources in health systems and its deliverables. In fact, the sizeable share of public money that is devoted to health and the ever-increasing cost pressures and demands to cut public expenditure, put health systems at the heart of many policy debates. In particular, challenges are multiple because of the medical, social and economic impacts of chronic disabling conditions. Together, these emphasize the need for an ambitious patient-empowering research policy and a cross-cutting, multidisciplinary approach to brain disorders.
Covering a range of mental and neurological disorders, the EBC Value of Treatment study examined health gains and socio-economic impacts resulting from best health interventions (pharmacological and psychosocial) in comparison with current care, or – in some cases – comparison with no treatment at all. Care pathways were mapped for each specific disorder along the whole care process from prevention, prodromal, early diagnosis to disease management in order to identify the major unmet needs and causes for treatment gaps (both those needing research and better evidence to inform treatment decisions and those needing better organization of services).
The following research questions were addressed to examine the best options for optimizing research and care for brain disorders:
■ What is the scale of current unmet needs in health care in Europe? What is the size of so-called “treatment gaps”, not only within the provision of medicines and medical devices, but also within health care systems and services? Considering obstacles such as misdiagnosis, delayed treatment, inadequate treatment, limited access to care due to country healthcare infrastructure or unaffordable access to care and pricing including therapies, reimbursement and social safety net cutbacks5… and non-adherence. What are the socio-economic benefits of targeting these gaps (e.g. avoidable costs…)? What have we learned from the “Patient Journey” or the patient care pathway analysis? What about the potential benefits of seamless, coordinated care combining effective team care and patient-centred care planning?
■ What is the added value of the Value of Treatment study? What are the new research developments in early intervention to improve [primary and secondary] prevention and treatment, knowing that, as of today, there is no cure?
■ How can we ensure that evidence built from robust research can have an impact on policy? What are the priorities for policy making in the current context of health systems reforms (articulating their impact investment social return) while continuing in investing in health (“health is wealth”) and legislation implementation? There is still no cure for most brain disorders; hence, it is necessary to focus on risk reduction, preclinical and early detection and diagnosis, and timely intervention. Primary and secondary prevention strategies remain essential (available diagnostic tools for neurological disorders and routine mental health screening). More research is needed to understand the causes but also the progression of brain disorders and to develop new treatments that do not only symptomatically improve the condition but may modify, i.e. slow down, or even stop their course.
Early detection and intervention with the necessary psychosocial support is also crucial to reduce stigmatization and fear of disclosure.
The solutions proposed by VoT experts are clearly identified. Results from the case studies provide important new insights into recent progress in the areas of pharmacology and biopsychosocial approach, as well as in relation to healthcare services delivery, continuous care and care networks.
The case studies results highlight the need for implementation of evidence-based guidelines that emphasize cost-effective, coordinated healthcare interventions in order to develop better prevention and timely treatment— “Brain: time matters”.