In this context, cross-country comparability of services, their costs, and outcomes is critical to deriving valid policy guidance based on international health economic evidence. The consequences are in turn felt throughout the entire economy. The failure to provide mental healthcare services in time hence propels an unmet need for care in the population. On the other hand, the individual’s need for mental healthcare services increases, which critically stretches the available resources in the healthcare system. The fiscal consequence is the loss of important tax revenues. This, in turn, has two relevant fiscal consequences: on the one hand, mental health conditions lower the individuals’ possibilities to participate in the labor force, reducing their productivity (sickness absence, presenteeism) or barring them from participating altogether. However, policymakers are typically under pressure to consolidate public budgets in the aftermath of economic crises, and the implementation of ill-devised austerity measures can further fuel the negative effects of economic crises on health. Adequate social security nets tend to mitigate such adverse health effects. Greece, too, saw a rise in deaths from suicides as well as in the prevalence of mental health problems. In Spain, for instance, where the economy and housing market were severely hit by the Great Recession from 2007 to 2009, evidence from primary care centers suggests that the frequency of mood, anxiety, somatoform, and alcohol-related disorders increased substantially in the aftermath of the Great Recession. The economic crisis exerts upward pressure on the incidence of mental health conditions in the population. The circular character of this relationship aggravates this issue. In the challenging environment of health care expenditure growing faster than the economy at large in many European countries, such fiscal aspects have important implications for the sustainable financing of healthcare systems. Apart from the direct impacts in the microeconomic sphere of the mental health patients, they also extend to the macroeconomic level of national budgets. ![]() Mental health conditions have considerable economic impacts. The PECUNIA RUCs are available free of charge and aim to significantly improve the quality and feasibility of future economic evaluations and their transferability across mental health systems. Increased cross-country comparability by adopting a uniform methodology and definitions can advance the quality of evidence-based policy guidance derived from health economic evaluations. Even under standardized methods, notable limitations due to data-driven divergences in key costing parameters remain. The resulting PECUNIA RUCs are largely comparable across countries, with any causes for deviations (e.g., country-specific scope of services) transparently documented. This article presents the methodology and set of 36 externally validated, standardized reference unit costs (RUCs) for five health and social care services (general practitioner, dentist, help-line, day-care center, nursing home) in Austria, England, Germany, Hungary, The Netherlands, and Spain based on unambiguous service definitions using the extended DESDE PECUNIA coding framework. The European ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) aimed to harmonize the international unit cost development. ![]() Improving the efficiency of mental healthcare service delivery by learning from international best-practice examples requires valid data, including robust unit costs, which currently often lack cross-country comparability.
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