Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis.
BACKGROUND
There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders.


METHODS
A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Existing variables from a previous WHO-CHOICE regional CEA model were substantially revised. Treatments for depression, schizophrenia, bipolar disorder and epilepsy were analysed. The best available local data on epidemiology, intervention efficacy, current and target coverage, resource prices and salaries were used. Data were obtained from expert opinion, local hospital information systems, the Ministry of Health and literature reviews.


RESULTS
Treatment of epilepsy with a first generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457-1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168-3739 per DALY adverted).


CONCLUSIONS
This analysis gives the Ethiopian government a comprehensive overview of the expected costs, effectiveness and cost-effectiveness of introducing basic neuropsychiatric interventions.
Department of Global Public Health and Primary Care University of Bergen Postbox 7804, N- 5020 Bergen, kirstenbjp@gmail.com.
Kirsten Bjerkreim
KB
Strand
World Health Organization, Geneva, Switzerland.
Dan
D
Chisholm
College of Health Sciences, School of Medicine, Department of Psychiatry, University of Addis Abeba, Addis Ababa, Ethiopia and Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK.
Abebaw
A
Fekadu
Department of Global Public Health and Primary Care University of Bergen Postbox 7804, N- 5020 Bergen.
Kjell Arne
KA
Johansson
D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000191:economics / Q000628:therapy; D057191:Capacity Building / Q000191:economics* / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000628:therapy; D004827:Epilepsy / Q000188:drug therapy / Q000191:economics / Q000628:therapy; D005002:Ethiopia; D017048:Health Care Costs; D006801:Humans; D008605:Mental Health Services / Q000191:economics* / Q000458:organization & administration; D012559:Schizophrenia / Q000191:economics / Q000628:therapy
D000927:Anticonvulsants
Cost-effectiveness; ethics; mental health; neuropsychiatric disorders