Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness.
BACKGROUND
Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes.


OBJECTIVE
To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions.


METHODS
Narrative overview methodology.


CONCLUSIONS
Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.
Department of Psychiatry, University of Oxford, Oxford, UK.
Helen
H
Jack
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
Ryan G
RG
Wagner
School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa.
Inge
I
Petersen
PRICELESS SA (Priority Cost Effective Lessons in System Strengthening South Africa), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Rita
R
Thom
Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Charles R
CR
Newton
Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Alan
A
Stein
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana.
Kathleen
K
Kahn
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana.
Stephen
S
Tollman
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; PRICELESS SA (Priority Cost Effective Lessons in System Strengthening South Africa), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Karen.Hofman@wits.ac.za.
Karen J
KJ
Hofman
D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000191:economics* / Q000458:organization & administration; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology
South Africa; costs and cost analysis; economics; health planning; mental health; policy