Packages of Care for Attention-Deficit Hyperactivity Disorder in Low- and Middle-Income Countries

Flisher, Alan J.; Sorsdahl, Katherine; Hatherill, Sean; Chehil, Sonia

doi:10.1371/journal.pmed.1000235

Cited by 21 publications

(33 citation statements)

References 55 publications

(57 reference statements)

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“…Task shifting approaches that build the capacities of a range of care providers in community settings have been successfully adopted and can be instrumental for increasing access to care for individuals with a range of mental disorders in low-resource settings [14],[15]. Evidence on the effectiveness of provision of psychosocial interventions for intellectual disabilities and autism spectrum disorders by non-specialist providers in HICs is emerging [16].…”

Section: Introductionmentioning

confidence: 99%

Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Review

et al. 2013

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Section: Introductionmentioning

confidence: 99%

Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Review

et al. 2013

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“…39 Recent studies have pointed out the necessity of cost-effectiveness studies for LMICs, 40 but, to the best of our knowledge, the present work is the first to show an advantageous economic option for a chronic disease which can be treated with MPH-IR even in low-resource settings. 41 In addition, our study demonstrated that, in LMICs, investments in such analyses can reveal a favorable scenario in contrast with wealthy countries. To illustrate, the incremental cost per QALY gained with MPH-IR treatment seems to be much more attractive for the Brazilian public health system when compared to that of the UK, where the ICER was estimated at I$ 13,904/QALY, 42 or to the U.S. (I$ 18,717/QALY), 43 and even better if compared to atomoxetine treatment in Spain (I$ 43,427/QALY) 19 (original costs were d 9,177, US$ 14,758, and h 34,308, respectively).…”

Section: Discussionmentioning

confidence: 59%

“…In fact, according to international guidelines, combinations of treatment modalities are preferable to medication alone. 41 The main reasons for our choice of MPH-IR could be summarized as: the high costs of extended-release presentations, the absence of a specific policy for ADHD treatment by the Brazilian authorities, 45 and the high costs of adding combined treatments, as demonstrated by the MTA. 17 Lastly, the MPH-IR prices adopted are exclusively for the Brazilian government, which means they are lower than wholesale prices.…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Maia

Stella²,

Wagner

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

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“…Integrating mental health care into existing care systems (e.g., primary care clinics, NGOs, schools) is a pragmatic approach that can maximize the efficiency of resource investments [13, 18, 22, 31, 73]. Understanding mental health systems development is needed to promote translation of research into policy and practice.…”

Section: Global Mental Health: Lessons To Be Learnedmentioning

confidence: 99%

Closing the Mental Health Gap in Low-income Settings by Building Research Capacity: Perspectives from Mozambique

Sweetland

Oquendo

Sidat

et al. 2014

Annals of Global Health

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Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability (YLDs). Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, though non-allopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need and those who have access to mental health treatment include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. In Mozambique, the World Health Organization estimates only 0.04 psychiatrists per 100,000 population, representing 30 times less than the global median, and more than 150 times lower than the median in high income countries. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert. Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country’s ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and research partnerships are critical to building capacity, promoting bilateral learning between and among low- and high-income settings, ultimately reducing the mental health treatment gap worldwide. Through new research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (USA), Vanderbilt University (USA), and Universidade Federal de São Paulo (Brazil), we are working towards a North-South and South-South collaboration to build research capacity in Mozambique and other Portuguese-speaking African countries.

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Packages of Care for Attention-Deficit Hyperactivity Disorder in Low- and Middle-Income Countries

Abstract: In the sixth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Alan Flisher and colleagues discuss the treatment of attention-deficit hyperactivity disorder.

Cited by 21 publications

References 55 publications

Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Review

Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Review

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Closing the Mental Health Gap in Low-income Settings by Building Research Capacity: Perspectives from Mozambique

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