Cost-Effectiveness of Psychiatrists

To the Editor: The title of the article (“Are Psychiatrists Cost-Effective? An Analysis of Integrated Versus Split Treatment”) by Mantosh Dewan, M.D. (1), is misleading. Dr. Dewan modeled one measure of the costs associated with different potential treatments for unspecified psychiatric disorders and showed that integrated treatment could be less costly than split treatment. However, his analytic model did not address the issue of treatment effectiveness; it implicitly assumed that all the treatment combinations in the model were equally effective for a broad range of clinical conditions. We are not aware of any data that support this assumption. Therefore, although the article does provide further support for the contention examined in the article by Goldman et al. (2) that integrated treatment may not be more expensive than split treatment, it does not in any way provide information about the cost-effectiveness of either form of treatment (3). Although the more narrow focus of the study on cost (and not cost-effectiveness) is clearly stated in the study’s aims and methods, the title of the study and one of the primary conclusions of the study, that “When both medication and psychotherapy are indicated, a patient is best and most cost-effectively served by a psychiatrist providing both treatment modalities” (1, p. 325), misrepresent the study. This is an important area of research and clinical policy; however, in the field of psychiatry, we need to be careful not to overstate the case before relevant research has been conducted.