Value-Based Commissioning of Mental Health Services in England: A Feasibility Study Using Multicriteria Decision Analysis

Objectives: Improving mental health services through value-based investment is high priority in healthcare systems globally. However, there is lack of comprehensive and robust evidence on the value for money of these services that incorporates several value elements and public preferences. This study aims to demonstrate the application of multicriteria decision analysis (MCDA) in the assessment of 2 early intervention in psychosis (EIP) services in England. Methods: An MCDA-based evaluation using patient records was conducted to evaluate the value-for-money of 2 EIP services in South-East England: Oxfordshire (EIP-Oxf) and Buckinghamshire (EIP-Bucks). The assessment considered 5 value elements: years of life, quality of life (time to relapse), patient experience (disengagement rates), health inequality (time-to-relapse disparity), and average annual cost. Performance on each value element was estimated using generalized linear models and propensity score matching on electronic health records of 1127 patients. Total MCDA scores integrated standardized predicted means with relative weights that were derived in a previous study. Robustness was assessed using probabilistic sensitivity analysis and service affordability was illustrated in conditional multiattribute acceptability curves. Results: EIP-Oxf outperformed EIP-Bucks in overall scores (0.563 vs 0.552) and offered higher value per pound spend according to cost-per-value ratios (£10 438 per unit of value vs £12 655). Results were driven by lower annual cost per patient and health inequality in EIP-Oxf. Conclusions: MCDA can facilitate value-for-money assessments of mental health services, addressing gaps in comprehensive rationing frameworks. This approach provides a systematic, evidence-driven method for local decision making, with potential for broader healthcare applications.