title: Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Systems Financing, World Health Organization, Geneva, Switzerland. ChisholmD@who.int
authors.forename: Dan
authors.initials: D
authors.lastname: Chisholm
authors.forename: Oye
authors.initials: O
authors.lastname: Gureje
authors.forename: Sandra
authors.initials: S
authors.lastname: Saldivia
authors.forename: Marcelo
authors.initials: M
authors.lastname: Villalón Calderón
authors.forename: Rajitha
authors.initials: R
authors.lastname: Wickremasinghe
authors.forename: Nalaka
authors.initials: N
authors.lastname: Mendis
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000354:Africa, Western; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D001210:Asia, Southeastern; D003156:Community Mental Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D017059:Models, Econometric; D017146:Models, Organizational; D011613:Psychotherapy / Q000191:economics* / Q000706:statistics & numerical data; D040442:Public Health Informatics; D019057:Quality-Adjusted Life Years; D012559:Schizophrenia / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D013020:South America; D014944:World Health Organization
chemical_list: D014150:Antipsychotic Agents