Bulletin of the World Health Organization

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

Volume 86, Number 7, July 2008, 542-551

Table 3. Costs and effects of schizophrenia treatment

WHO region Africa
Americas
South-East Asia
WHO subregionor country SubregionD Nigeria SubregionB Chile SubregionB Sri Lanka
Total population (millions) 294.1 113.9 430.9 15.1 293.8 18.6
GDP per capita(I$, 2000) 1 381 903 7 833 9 636 3 915 3 292
Current coverage rate (% of cases treated now)a 25 20 50 80 40 50
Target coverage rate (% of cases to be treated) 80 70 80 90 80 80

Effectiveness (DALYs averted)b
Current situation 99 23 189 261 205 121
Older (typical) antipsychotic drug 200 124 295 302 319 241
Newer (atypical) antipsychotic drug 215 148 317 321 343 289
Older antipsychotic drug + psychosocial treatment 341 237 501 555 542 453
Newer antipsychotic drug + psychosocial treatment 350 261 514 575 557 529

Cost (I$/LCU per capita, 2000)c I$ Naira I$ I$ Pesos I$ I$ Rupees I$
Current situation 0.51 5 0.12 2.98 435 1.69 2.18 7 0.35
Older (typical) antipsychotic drug 0.74 16 0.39 3.13 392 1.52 2.10 11 0.57
Newer (atypical) antipsychotic drug 2.86 427 10.67 6.42 730 2.83 5.72 27 1.37
Older antipsychotic drug + psychosocial treatment 0.80 16 0.40 3.59 487 1.89 2.36 22 1.12
Newer antipsychotic drug + psychosocial treatment 2.93 428 10.70 6.93 826 3.20 6.01 39 1.96

Cost-effectiveness (I$/LCU per DALY averted)c I$ Naira I$ I$ Pesos I$ I$ Rupees I$
Current situation 5 174 209 430 5 236 15 770 1 664 113 6 450 10 680 58 276 2 914
Older (typical) antipsychotic drug 3 705 127 676 3 192 10 622 1 299 506 5 037 6 583 47 085 2 354
Newer (atypical) antipsychotic drug 13 295 2 882 052 72 051 20 289 2 271 496 8 804 16 689 94 848 4 742
Older antipsychotic drug + psychosocial treatment 2 350 66 790 1 670 7 158 877 211 3 400 4 356 49 231 2 462
Newer antipsychotic drug + psychosocial treatment 8 374 1 637 168 40 929 13 476 1 437 717 5 573 10 804 73 937 3 697

Incremental cost-effectiveness (I$/LCU per DALY averted)d I$ Naira I$ I$ Pesos I$ I$ Rupees I$
Current situation Dominated Dominated Dominated Dominated Dominated Dominated
Older (typical) antipsychotic drug Dominated Dominated Dominated Dominated Dominated 47 085 2 354
Newer (atypical) antipsychotic drug Dominated Dominated Dominated Dominated Dominated Dominated
Older antipsychotic drug + psychosocial treatment 2 350 66 790 1 670 7 158 877 211 3 400 4 356 51 674 2 584
Newer antipsychotic drug + psychosocial treatment 237 286 16 804 726 420 118 253 554 17 412 144 67 489 255 820 222 239 11 112

DALY, disability-adjusted life year; I$, International dollar; LCU, local currency unit.a Estimated level of formal treatment coverage in the population (excludes informal health-care provision).b Discounted, age-weighted DALYs averted by intervention per year per 1 million population, relative to no intervention.c Millions of currency units (discounted at 3%) per 1 million population per year, i.e. per capita.d The additional cost needed to avert one extra DALY (compared to the next most cost-effective option).

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