Cost-effectiveness of WHO Problem Management Plus for adults with mood and anxiety disorders in a post-conflict area of Pakistan: randomised controlled trial
| Autor: | Zill-e Huma, Duolao Wang, Atif Rahman, Tao Chen, Dan Chisholm, Saeed Farooq, Mark van Ommeren, Syed Usman Hamdani |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty wm_100 Cost effectiveness Cost-Benefit Analysis Psychological intervention wa_395 Anxiety Hospital Anxiety and Depression Scale World Health Organization RC435 41b6e438 law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Medicine Humans Pakistan 030212 general & internal medicine Depression (differential diagnoses) wm_140 business.industry Depression Mental health Anxiety Disorders R1 030227 psychiatry wm_20 Psychiatry and Mental health Mood Treatment Outcome Physical therapy RC0321 medicine.symptom business RC |
| Zdroj: | The British journal of psychiatry : the journal of mental science |
| ISSN: | 0007-1250 1472-1465 |
| Popis: | BackgroundWith the development of evidence-based interventions for treatment of priority mental health conditions in humanitarian settings, it is important to establish the cost-effectiveness of such interventions to enable their scale-up.AimsTo evaluate the cost-effectiveness of the Problem Management Plus (PM+) intervention compared with enhanced usual care (EUC) for common mental disorders in primary healthcare in Peshawar, Pakistan. Trial registration ACTRN12614001235695 (anzctr.org.au).MethodWe randomly allocated 346 participants to either PM+ (n = 172) or EUC (n = 174). Effectiveness was measured using the Hospital Anxiety and Depression Scale (HADS) at 3 months post-intervention. Cost-effectiveness analysis was performed as incremental costs (measured in Pakistani rupees, PKR) per unit change in anxiety, depression and functioning scores.ResultsThe total cost of delivering PM+ per participant was estimated at PKR 16 967 (US$163.14) using an international trainer and supervisor, and PKR 3645 (US$35.04) employing a local trainer. The mean cost per unit score improvement in anxiety and depression symptoms on the HADS was PKR 2957 (95% CI 2262–4029) (US$28) with an international trainer/supervisor and PKR 588 (95% CI 434–820) (US$6) with a local trainer/supervisor. The mean incremental cost-effectiveness ratio (ICER) to successfully treat a case of depression (PHQ-9 ≥ 10) using an international supervisor was PKR 53 770 (95% CI 39 394–77 399) (US$517), compared with PKR 10 705 (95% CI 7731–15 627) (US$102.93) using a local supervisor.ConclusionsThe PM+ intervention was more effective but also more costly than EUC in reducing symptoms of anxiety, depression and improving functioning in adults impaired by psychological distress in a post-conflict setting of Pakistan. |
| Databáze: | OpenAIRE |
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