Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis.
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.
Chisholm
Dan
D
Department of Health Systems Financing, World Health Organization, Geneva, Switzerland. ChisholmD@who.int
Gureje
Oye
O
Saldivia
Sandra
S
Villalón Calderón
Marcelo
M
Wickremasinghe
Rajitha
R
Mendis
Nalaka
N
Ayuso-Mateos
Jose-Luis
JL
Saxena
Shekhar
S
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
D014150:Antipsychotic Agents