The health and economic consequences of mental health treatment with benzodiazepines

A new research project led by Professor Fabrizio Mazzonna of the Institute of Economics (IdEP) of USI Faculty of Economics has received positive feedback from the Swiss National Science Foundation (SNSF). The study "Health and economic consequences of low-value mental health care: the case of benzodiazepines" focuses on the causes and consequences of the use of benzodiazepines to treat mental health problems. 

The incidence of disability and suicide caused by mental health problems is increasing worldwide. There are multiple reasons behind this, such as the increase in sleep and anxiety problems, leading to the onset of other mental and physical illnesses. The pandemic has also led to a mental health crisis with an altered lifestyle, increased anxiety and depression. Growing awareness of the social and economic burden of mental illness has contributed to rising costs for mental health care and the growing consumption of psychotropic drugs. 

"In this project," explains Professor Fabrizio Mazzonna, "we focus on the causes and consequences of the use of benzodiazepines, a class of drugs commonly used to treat sleep and anxiety problems, often in combination with others to treat mental problems. These drugs appear to be effective in the short term but ineffective in solving the root causes of these mental problems. In addition, they can be addictive in the long run. Despite international campaigns to reduce their use (Choosing wisely), these drugs continue to be prescribed and consumed by a large share of the population. Recent estimates show that in Switzerland, more than 8 per cent of the population regularly takes these drugs, and the percentage may rise to 20 per cent among people over 65. This is without considering the co-use of these drugs with other psychotropic drugs such as antidepressants and opioids." 

A twofold goal 
 
The objective of this study is twofold: 

1. to analyse the causes of benzodiazepine overuse, focusing mainly on the role of physicians and interaction with patients; 
2. to analyse the long-term health and career consequences in people who use benzodiazepines; 
 
"To achieve these two objectives," Fabrizio Mazzonna continues, "we use different sources of administrative and insurance data from two countries, the Netherlands and Switzerland, which have two very different healthcare systems.

For example, by pooling data on physicians' prescriptions, their diagnoses, and the characteristics of their patients, we can compare the health and working careers of patients with the same diagnosis but treated differently by their physicians over time. In particular, we will tap into the consequences of being treated by a physician who frequently prescribes benzodiazepines compared to a physician who prescribes less while complying with guidelines." 

Who is involved? 

"The project also involves Joachim Marti, Professor of Health Economics in Lausanne, with whom we will be looking at prescriptions in the senior population and nursing homes, and Pieter Bakx, Professor of Health Economics at Erasmus University Rotterdam, with whom I am collaborating on the Dutch data analysis."  

 
What might be the practical implications of this work? 

"Although there is clinical evidence on the addiction caused by long-term use of these drugs, there is not much evidence on the long-term health consequences (costs and health), which does not appear to be consistent with current practice style. In contrast, little to nothing is known about what happens to the careers of the people treated. Should the results clearly indicate detrimental effects from the current use of these drugs, the study could lead to the revision of official guidelines to achieve greater efficacy in treating a large segment of the population with mental health problems, as well as savings for the health care system and productivity gains." 

Why is it important to address this issue? 

"Mental health determines individual well-being and participation in social life. The rising incidence of mental problems was at the centre of the international health agenda even before the surge in mental problems observed during the recent pandemic. While increased awareness of the importance of mental health has led to more people being treated, there is much debate about the best treatment. In particular, the striking increase observed in the use of psychotropic drugs over the past 30 years is now the focus of scientific debate."