Choosing cost-effective interventions in psychiatry: results from the CHOICE programme of the World Health Organization.
There is increasing recognition at both the international and national level of the disease burden attributed to psychiatric disorders, yet little is known about how much of this burden is or could be averted by current or scaled-up implementation of effective interventions. In addition, little is known about the costs and cost-effectiveness of such interventions in most regions of the world, even though such information is of direct relevance to increased investment and service development. This research report provides an overview of the mental health component of the World Health Organization's CHOICE project, the aim of which is to generate cost-effectiveness evidence for a large number of interventions for leading contributors to disease burden in a range of geographical and epidemiological settings around the world. To date, expected costs (expressed in international dollars) and effects (measured in terms of disability adjusted life years, DALYs) of key pharmacological and psychosocial interventions have been modelled for schizophrenia, bipolar disorder, depression and panic disorder. The results of this analysis indicate that the most efficient interventions for common mental disorders (depression and panic disorder) can be considered very cost-effective (each DALY averted costs less than one year of average per capita income), while community-based interventions for more severe mental disorders using older antipsychotic and mood stabilising drugs meet the criterion for being cost-effective (each DALY averted costs less than three times the average annual income). These findings provide relevant new information to health policy makers regarding the relative value of investing in psychiatric care, and in so doing may help to remove one of many remaining barriers to a more appropriate public health response to the burden of these conditions.
Chisholm
Dan
D
Department for Health System Financing, Expenditure and Resource Allocation, and Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.