Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis
Dan Chisholm, Oye Gureje, Sandra Saldivia, Marcelo Villalón Calderón, Rajitha Wickremasinghe, Nalaka Mendis, Jose-Luis Ayuso-Mateos, Shekhar Saxena
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.
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.
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.
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.