Schizophrenia treatment in the developing world : an interregional and multinational cost-effectiveness analysis

• Published in: Bulletin of the World Health Organization Vol. 86; no. 7; pp. 542 - 551
• Main Authors: CHISHOLM, Dan, GUREJE, Oye, SALDIVIA, Sandra, VILLALON CALDERON, Marcelo, WICKREMASINGHE, Rajitha, MENDIS, Nalaka, AYUSO-MATEOS, Jose-Luis, SAXENA, Shekhar
• Format: Journal Article
• Language: English
• Published: Genève Organisation mondiale de la santé 01.07.2008; World Health Organization; The World Health Organization
• Subjects: Adult and adolescent clinical studies; Africa, Western; Antipsychotic Agents - economics; Antipsychotic Agents - therapeutic use; Antipsychotics; Asia, Southeastern; Biological and medical sciences; Community Mental Health Services - economics; Cost analysis; Cost-Benefit Analysis; Developing Countries; Disease; Drugs; Epidemiology; Fatalities; Health Care Costs - statistics & numerical data; Hospitals; Humans; Intervention; LDCs; Length of stay; Medical personnel; Medical sciences; Mentally Ill Persons - statistics & numerical data; Models, Econometric; Models, Organizational; Population; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotherapy - economics; Psychotherapy - statistics & numerical data; Psychotropic drugs; Public Health Informatics; Quality-Adjusted Life Years; Regions; Remission (Medicine); Schizophrenia; Schizophrenia - economics; Schizophrenia - epidemiology; Schizophrenia - therapy; South America; Validity; World Health Organization; Asia, Southeastern; South America; Africa, Western; Psychosis; Human; Treatment; Health economy; Developing countries; Schizophrenia; Cost analysis; Public health; Cost efficiency analysis
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.07.045377

Schizophrenia is a highly disabling disease and is costly to treat. We set out to establish what are the most cost-effective interventions applicable to developing regions and countries. Analysis was undertaken at the level of three WHO subregions spanning the Americas, Africa and South-East Asia, and subsequently in three member states (Chile, Nigeria and Sri Lanka). A state transition model was used to estimate the population-level health impact of older and newer antipsychotic drugs, alone or in combination with psychosocial intervention. Total population-level costs (in international dollars or local currencies) and effectiveness (measured in disability-adjusted life years averted) were combined to form cost-effectiveness ratios. The most cost-effective interventions were those using older antipsychotic drugs combined with psychosocial treatment, delivered via a community-based service model (I$ 2350-7158 per disability-adjusted life year averted across the three subregions, I$ 1670-3400 following country-level contextualisation within each of these subregions). The relative cost-effectiveness of interventions making use of newer, "atypical" antipsychotic drugs is estimated to be much less favourable. By moving to a community-based service model and selecting efficient treatment options, the cost of substantially increasing treatment coverage is not high (less than I$ 1 investment per capita). Taken together with other priority-setting criteria such as disease severity, vulnerability and human rights protection, this study suggests that a great deal more could be done for persons and families living under the spectre of this disorder.