[The economics of mental health and health care- a blind spot?].

Mental disorders are associated with an immense burden of disease for patients, their social environment and for society as a whole. Neuropsychiatric diseases have been estimated to account for 27% of disability adjusted life years (DALYs) in the Euro-A region and have thus more impact on the global burden of disease than cardiovascular diseases or neoplasms. In the population younger than 30 years even 65% of years lost due to disability are due to neuropsychiatric disorders. Moreover, the economic consequences of mental disorders pose a significant challenge on health care systems. For example, it has been estimated that 10% of direct health care costs in Germany were caused by mental and behavioural disorders in 2002. With limited available resources, it is becoming increasingly important to allocate health care budgets efficiently. It is therefore surprising that mental disorders as compared to other diseases are considerably underrepresented in the health economic evaluation of health care interventions. Health economic research has concentrated on the pharmacoeconomic assessment of new drugs so far while other interventions and alternative ways of care delivery, e.g., specialized day care, have rarely been subject to health economic evaluation and are thus systematically disadvantaged. Causes underlying the reservation towards mental disorders in health economics are being discussed and future perspectives are outlined.