Objective: To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results. Methods: We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities. Results: We identified 5 COI and 8 EE, of which 6 were cost-minimization analyses and 2 were cost-effectiveness analyses. All studies used patient level data collected between 1980 and 2004 and were predominantly conducted in the USA (n = 10). COI found annual excess health care costs of somatizing patients between 432 and 5,353 USD in 2006 values. Indirect costs were estimated by only one EE and added up to about 18,000 USD per year. In EE, educational interventions for physicians as well as cognitive-behavioral therapy approaches for patients were evaluated. For both types of interventions, effectiveness was either shown within EE or by previous studies. Most EE found (often insignificant) cost reductions resulting from the interventions, but only two studies explicitly combined changes in costs with data on effectiveness to cost-effectiveness ratios (ratio of additional costs to additional effects). Conclusions: Medically unexplained symptoms cause relevant annual excess costs in health care that are comparable to mental health problems like depression or anxiety disorders and which may be reduced by interventions targeting physicians as well as patients. More extensive research on indirect costs and cost-effectiveness is needed.

Keywords:
Somatization disorder, Medically unexplained symptoms, Economic evaluations, Cost of illness, Cost-effectiveness
1.
Fink P, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P: Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics 1999;40:330–338.
2.
de Waal MW, Arnold IA, Eekhof JA, van Hemert AM: Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. Br J Psychiatry 2004;184:470–476.
3.
Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F: Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the functional illness in primary care (FIP) study. Psychol Med 2005;35:1175–1184.
4.
Huijbregts KM, van Marwijk HW, de Jong FJ, Schreuders B, Beekman AT, van der Feltz-Cornelis CM: Adverse effects of multiple physical symptoms on the course of depressive and anxiety symptoms in primary care. Psychother Psychosom 2010;79:389–391.
5.
Smith GR Jr: The course of somatization and its effects on utilization of health care resources. Psychosomatics 1994;35:263–267.
6.
Hiller W, Fichter MM: High utilizers of medical care: a crucial subgroup among somatizing patients. J Psychosom Res 2004;56:437–443.
7.
Smith GR Jr, Monson RA, Ray DC: Psychiatric consultation in somatization disorder. A randomized controlled study. N Engl J Med 1986;314:1407–1413.
8.
Kashner TM, Rost K, Smith GR, Lewis S: An analysis of panel data. The impact of a psychiatric consultation letter on the expenditures and outcomes of care for patients with somatization disorder. Med Care 1992;30:811–821.
9.
Briggs AH, O’Brien BJ: The death of cost-minimization analysis? Health Econ 2001;10:179–184.
10.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes, ed 3. Oxford, Oxford University Press, 2005.
11.
Annemans L, Le Lay K, Taieb C: Societal and patient burden of fibromyalgia syndrome. Pharmacoeconomics 2009;27:547–559.
12.
Agarwal N, Spiegel BM: The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol Clin North Am 2011;40:11–19.
13.
Organisation for Economic Cooperation and Development: OECD Health Data 2009: Statistics and Indicators for 30 Countries. 2009.
14.
Smith GR Jr, Monson RA, Ray DC: Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization. Arch Intern Med 1986;146:69–72.
15.
Smith GR Jr, Rost K, Kashner TM: A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Arch Gen Psychiatry 1995;52:238–243.
16.
Labott SM, Preisman RC, Popovich J Jr, Iannuzzi MC: Health care utilization of somatizing patients in a pulmonary subspecialty clinic. Psychosomatics 1995;36:122–128.
17.
Barsky AJ, Ettner SL, Horsky J, Bates DW: Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care 2001;39:705–715.
18.
Barsky AJ, Orav EJ, Bates DW: Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 2005;62:903–910.
19.
McFall M, Tackett J, Maciejewski ML, Richardson RD, Hunt SC, Roberts L: Predicting costs of Veterans Affairs health care in Gulf War veterans with medically unexplained physical symptoms. Mil Med 2005;170:70–75.
20.
Luo Z, Goddeeris J, Gardiner JC, Smith RC: Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial. Psychiatr Serv 2007;58:1079–1086.
21.
Seivewright H, Green J, Salkovskis P, Barrett B, Nur U, Tyrer P: Cognitive-behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial. Br J Psychiatry 2008;193:332–337.
22.
Hiller W, Fichter MM, Rief W: A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness. J Psychosom Res 2003;54:369–380.
23.
Morriss R, Gask L, Ronalds C, Downes-Grainger E, Thompson H, Leese B, Goldberg D: Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs. Fam Pract 1998;15:119–125.
24.
Allen LA, Woolfolk RL, Escobar JI, Gara MA, Hamer RM: Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial. Arch Intern Med 2006;166:1512–1518.
25.
Efron B, Tibshirani R: Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat Sci 1986;1:54–77.
26.
Luppa M, Heinrich S, Angermeyer MC, König HH, Riedel-Heller SG: Cost-of-illness studies of depression: a systematic review. J Affect Disord 2007;98:29–43.
27.
Konnopka A, Leichsenring F, Leibing E, König HH: Cost-of-illness studies and cost-effectiveness analyzes in anxiety disorders: a systematic review. J Affect Disord 2009;114:14–31.
28.
Fink P, Rosendal M: Recent developments in the understanding and management of functional somatic symptoms in primary care. Curr Opin Psychiatry 2008;21:182–188.
29.
Toft T, Rosendal M, Ornbol E, Olesen F, Frostholm L, Fink P: Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study). Psychother Psychosom 2010;79:227–237.
30.
van Bokhoven MA, Koch H, van der Weijden T, Grol RP, Kester AD, Rinkens PE, Bindels PJ, Dinant GJ: Influence of watchful waiting on satisfaction and anxiety among patients seeking care for unexplained complaints. Ann Fam Med 2009;7:112–120.
31.
Henningsen P, Zipfel S, Herzog W: Management of functional somatic syndromes. Lancet 2007;369:946–955.
32.
van der Feltz-Cornelis CM, van Oppen P, Ader HJ, van Dyck R: Randomised controlled trial of a collaborative care model with psychiatric consultation for persistent medically unexplained symptoms in general practice. Psychother Psychosom 2006;75:282–289.
33.
Fava GA, Sonino N: Psychosomatic medicine: a name to keep. Psychother Psychosom 2010;79:1–3.
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2012
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