Commissioning for Better Health
Case Study - anti-depressants overspend
A Mental Health Trust was overspending on its anti-depressants budget with prescribing per head well over twice the national average. However, its outcomes were worse than national and comparable cluster averages.
A PBMA (Programme Budget Marginal Analysis) exercise was commenced to look at alternatives to the continuous over-prescribing and over-spend and hence a disinvestment in anti-depressant use. Several alternative projects were developed that addressed the mental health of the community and a set of commissioning criteria and business cases developed with stakeholders. Each of these schemes was scored for benefits that matched these criteria and they were also costed. They were then compared for cost-effectiveness (using a visually quick method: see below diagram).
The analysis found that the self-help and community based schemes were more cost-effective than schemes involving professional help. It made economic sense to reinvest some of the resources tied up in anti-depressants. With the funds released from the drug budget some of these new schemes were highly affordable and could improve patient outcomes and community well-being.