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Mostert CM, Aballa A, Khakali L, Njoroge W, Shah J, Hasham S, Merali Z, Atwoli L. The Shortfalls of Mental Health Compartment Models: A Call to Improve Mental Health Investment Cases in Developing Countries. Value Health Reg Issues 2024; 41:48-53. [PMID: 38237329 DOI: 10.1016/j.vhri.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/30/2023] [Accepted: 11/26/2023] [Indexed: 04/17/2024]
Abstract
OBJECTIVES There are irregularities in investment cases generated by the Mental Health Compartment Model. We discuss these irregularities and highlight the costing techniques that may be introduced to improve mental health investment cases. METHODS This analysis uses data from the World Bank, the World Health Organization Mental Health Compartment Model, the United Nations Development Program, the Kenya Ministry of Health, and Statistics from the Kenyan National Commission of Human Rights. RESULTS We demonstrate that the Mental Health Compartment Model produces irrelevant outcomes that are not helpful for clinical settings. The model inflated the productivity gains generated from mental health investment. In some cases, the model underestimated the economic costs of mental health. Such limitation renders the investment cases poor in providing valuable intervention points from the perspectives of both the users and the providers. CONCLUSIONS There is a need for further calibration and validation of the investment case outcomes. The current estimated results cannot be used to guide service provision, research, and mental health programming comprehensively.
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Affiliation(s)
- Cyprian M Mostert
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya; Department of Population Health, Aga Khan University, Nairobi, Kenya.
| | - Andrew Aballa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Linda Khakali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Willie Njoroge
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Samim Hasham
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Lukoye Atwoli
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya; Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya
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Mutyambizi-Mafunda V, Myers B, Sorsdahl K, Chanakira E, Lund C, Cleary S. Economic evaluation of psychological treatments for common mental disorders in low- and middle-income countries: a systematic review. Health Policy Plan 2022; 38:239-260. [PMID: 36005943 PMCID: PMC9923379 DOI: 10.1093/heapol/czac069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
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 and Cochrane library) and the African Journals Online (AJoL) 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 (12), some were cost-utility analyses (5), with one cost-benefit analysis or combinations of economic evaluations (8). Most interventions were considered either cost-effective or potentially cost-effective (22), with 3 interventions being not cost-effective. Limitations were noted regarding appropriateness of conclusions drawn on cost-effectiveness, the use of cost-effectiveness thresholds and application of 'societal' incremental cost-effectiveness ratios to reflect value for money (VfM) of treatments. Non-specialist health workers (NSHWs) delivered most of the treatments (16) for low-cost delivery at scale, and costs should reflect the true opportunity cost of NSHWs' time to support the development of a sustainable cadre of health care providers. There is a 4-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 the World Health Organization recommended first-line treatments of CMDs. We suggest impact inventories to capture societal economic gains and propose a VfM assessment framework to guide researchers in evaluating cost-effectiveness.
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Affiliation(s)
- Vimbayi Mutyambizi-Mafunda
- *Corresponding author. Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa. E-mail:
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, WA 6102, Australia,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg, Cape Town 7505, South Africa,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, 1st Floor, Neuroscience Institute, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa
| | - Esther Chanakira
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s Global Health Institute, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
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Wechsberg WM, van der Drift I, Howard BN, Myers B, Browne FA, Bonner CP, Carney T, Ndirangu J, Washio Y. Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8661. [PMID: 35886515 PMCID: PMC9316816 DOI: 10.3390/ijerph19148661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022]
Abstract
Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa.
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Affiliation(s)
- Wendee M. Wechsberg
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27708, USA
| | - Isa van der Drift
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Brittni N. Howard
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Bronwyn Myers
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7580, South Africa; (B.M.); (T.C.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth 6102, Australia
| | - Felicia A. Browne
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Courtney Peasant Bonner
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tara Carney
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7580, South Africa; (B.M.); (T.C.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Jacqueline Ndirangu
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Yukiko Washio
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19122, USA
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