How to scale-up neuropsychiatric interventions in Ethiopia

Kirsten Bjerkreim Strand and Kjell Arne Johansson from the Global Health Priorities Research Group have together with Dan Chisholm and Abebaw Fekadu published a new paper in Health Policy and Planning. In a contextualized cost-effectiveness analysis they explore the health gains and expected budget impacts when scaling up treatment for commom neuropsychiatric diseases in Ethiopia.

They write: "Mental and behavioral disorders contribute to around 19% of all years of life lost due to disability (YLD) in Eastern Sub-Saharan Africa. Even though effective treatment exists, major depression is the second leading cause of YLD both globally and in the sub-region of Eastern Sub-Saharan Africa. Mental illness greatly influences the patients’ overall health, economic situation and social integration." The potential health impact for scaling up treatment is therefore big and this study provides valuable info.

Main findings from the study are that 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). Depending on the willingness-to-pay several interventions can be viewed as cost-effective. A discussion on how to weight cost-effectiveness compared with other fairness concerns is needed.

The same authors have also published a working paper for Disease Control Priorities 3 exploring the same subject. Here they have done an extended cost-effectiveness analysis (ECEA) on the data published in the original study. This working paper was recently refered to in a New York Times article on mental health in Africa.