Abstract
Introduction There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders.Methods A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Existing variables from a previous WHO-CHOICE regional CEA model were substantially revised. Treatments for depression, schizophrenia, bipolar disorder and epilepsy were analysed. The best available local data on epidemiology, intervention efficacy, current and target coverage, resource prices and salaries were used. Data were obtained from expert opinion, local hospital information systems, the Ministry of Health and literature reviews.Results Treatment of epilepsy with a first generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457–1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168–3739 per DALY adverted).Conclusion This analysis gives the Ethiopian government a comprehensive overview of the expected costs, effectiveness and cost-effectiveness of introducing basic neuropsychiatric interventions.
Highlights
There is an immense need for scaling-up neuropsychiatric care in low-income countries
A cost-effectiveness analysis of basic neuropsychiatric interventions in an Ethiopian setting based on a proposed set of interventions from the Ethiopian Ministry of Health
The aim of this study is: (1) to do a contextualized cost-effectiveness analyses (CEAs) for an Ethiopian setting examining a range of interventions for depression, schizophrenia, bipolar disorder and epilepsy; and (2) to illustrate the differences in expected population health and budget impact across these disorders
Summary
There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders. Methods A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Mental and behavioral disorders contribute to around 19% of all years of life lost due to disability (YLD) in Eastern Sub-Saharan Africa (Vos et al 2012). Even though effective treatment exists, major depression is the second leading cause of YLD both globally and in the sub-region of Eastern Sub-Saharan Africa. Mental disorders are a financial risk factor and can substantially influence ability to work and household prosperity. Poor populations are at higher risk for mental illnesses (Lund et al 2010). Ethiopian studies have shown that mental illness is associated with a high degree of stigma (Shibre et al 2001; Assefa et al 2012)
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