Mental health economics: a prospective study on psychological flourishing and associations with healthcare costs and sickness benefit transfers in Denmark

Abstract Background Escalating healthcare expenditures highlight the need to identify modifiable predictors of the use and costs of healthcare and sickness benefit transfers. We conducted a prospective analysis on Danish data to determine the costs associated with flourishing as compared to the below threshold level of flourishing. Methods We used data from a 2016 Danish survey of 3,508 adults, which was linked to Danish register data. Flourishing was assessed with a validated psychological well-being scale. A two-part regression model was used to predict 2017 costs while adjusting for 2016 costs, demographic variables, and health status, including psychiatric morbidity and health behaviours. Results Flourishing was associated with lower per person healthcare costs ($-687.7, 95% CI = $-1,295.0, $-80.4) and sickness benefit transfers ($-297.8, 95% CI = $-551.5, $-44.0), compared to the below threshold level. Extrapolated to the Danish population (4.1M people aged 16+ years), flourishing was associated with lower healthcare costs and sickness benefit transfers amounting to $-1.2B (95% CI = $-2.3bn, $-149.0M). Conclusions Flourishing is associated with considerably lower health-related government expenditure. Substantial reductions could potentially be achieved by increasing the number of people who are flourishing in the population.