title: Health Gains and Financial Protection Provided by the Ethiopian Mental Health Strategy: an Extended Cost-Effectiveness Analysis.
abstract: BACKGROUND
  Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy.
  
  
  METHODS
  A methodology of extended cost-effectiveness analysis (ECEA) is applied to MN health care in Ethiopia. The impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy) and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact.
  
  
  RESULTS
  The MN package is expected to cost US$177 million and gain 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. The health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. In addition, economic benefits of US$ 51 million annually are expected from depression treatment in Ethiopia as a result of productivity gains, equivalent to 78% of the investment cost.
  
  
  CONCLUSIONS
  The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The ECEA approach seems to fit well with the current policy challenges and captures important equity concerns of scaling up MN programmes.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.|Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Kjell Arne
authors.initials: KA
authors.lastname: Johansson
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.
authors.forename: Kirsten Bjerkreim
authors.initials: KB
authors.lastname: Strand
authors.affiliation: College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.|Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva.
authors.forename: Dan
authors.initials: D
authors.lastname: Chisholm
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology; D005002:Ethiopia; D005380:Financing, Government / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008603:Mental Health; D011203:Poverty; D011619:Psychotropic Drugs / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D011619:Psychotropic Drugs
keywords: Equity; ethics; mental health; poverty reduction strategy papers; priority setting