Economic evaluation of psychological treatments for common mental disorders in low- and middle-income countries: a systematic review

Abstract

Common mental disorders (CMDs) constitute a major public health and economic burden on low- and middle-income countries (LMICs). Systematic reviews of economic evaluations of psychological treatments for CMDs are limited. This systematic review examines methods, reports findings, and appraises the quality of economic evaluations of psychological treatments for CMDs in LMICs. We searched a range of bibliographic databases (including PubMed, EconLit, APA-PsycINFO, Cochrane library) and the African Journals Online and Google Scholar platforms. We used a pre-populated template to extract data and the Drummond & Jefferson checklist for quality appraisal. We present results as a narrative synthesis. The review included 26 studies mostly from Asia (12) and Africa (9). The majority were Cost-Effectiveness Analyses (CEAs) (12), some were Cost-Utility Analyses (CUAs) (5), with one Cost-Benefit Analysis (CBA), or combinations of economic evaluations (8). Most interventions were considered either cost-effective or potentially cost-effective (22), with 3 interventions not cost-effective. Limitations were noted regarding appropriateness of conclusions drawn on cost-effectiveness, the use of Cost-Effectiveness Thresholds (CETs), and application of “societal” Incremental Cost-Effectiveness Ratios (ICERs) to reflect value for money of treatments. Non-specialist health workers (NSHW) delivered most of the treatments (16) for low-cost delivery at scale, and costs should reflect the true opportunity cost of NSHW time to support the development of a sustainable cadre of health care providers. There is a four-fold increase in economic evaluations of CMD psychological treatments in the last decade over the previous one. Yet, findings from this review highlight the need for better application of economic evaluation methodology to support resource allocation towards World Health Organization (WHO) recommended first line treatments of CMDs. We suggest impact inventories to capture societal economic gains and propose a value for money assessment framework to guide researchers in evaluating cost-effectiveness.

An Inquire of Cost and Benefits of Structural Interventions: The Case of Medical Legal Partnerships for People Living with HIV in Philadelphia, PA

“…In this context, HIV medical and public health interventions have received extensive attention in the economic evaluation literature. Losses in quality of life among PLWH due to psychosocial factors such as depression and substance use have fostered cost-bene t and cost-effectiveness analyses of behavioral interventions for PLWH [ 31,32,33 ]. Yet, contributions to economic evaluation of "public health interventions that promote health by altering the structural context within which health is produced and reproduced" [ 34 ] are modest but emerging.…”

Interventions to reduce wait times for adolescents seeking mental health services: a scoping review protocol

“…While not all adolescents experiencing these symptoms meet diagnostic criteria for mood or anxiety disorders, the peak age of onset for most mental disorders is 14.5 years,10 and longitudinal evidence demonstrates that symptoms of mental health difficulties in late adolescence persist into young adulthood 11. Therefore, timely access to mental health services for adolescents experiencing mental health difficulties is critical to reducing the persistence and progression of these difficulties12 and the long-term costs associated with untreated mental disorders 13…”

“… 11 Therefore, timely access to mental health services for adolescents experiencing mental health difficulties is critical to reducing the persistence and progression of these difficulties 12 and the long-term costs associated with untreated mental disorders. 13 …”

Determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel

“…paramount for averting these negative consequences (Reynolds et al, 2012) and curbing enduring economic burdens in the long term (Mutyambizi-Mafunda et al, 2023). Nonetheless, many adolescents with mental health problems often go unrecognized and untreated (WHO, 2021).…”

“…Mental health challenges can exert profound adverse effects on the social, emotional, and academic development of adolescents, leading to issues such as learning difficulties, school dropout, relationship problems, an elevated risk of substance misuse, and even suicidal behavior (Bentley et al, 2016; Hossain et al, 2022; Patel et al, 2018; Radez et al, 2021). Addressing mental health issues in adolescents is paramount for averting these negative consequences (Reynolds et al, 2012) and curbing enduring economic burdens in the long term (Mutyambizi-Mafunda et al, 2023). Nonetheless, many adolescents with mental health problems often go unrecognized and untreated (WHO, 2021).…”