Economic threshold analysis of delivering a task-sharing treatment for common mental disorders at scale: the Friendship Bench, Zimbabwe.
Economic threshold analysis of delivering a task-sharing treatment for common mental disorders at scale: the Friendship Bench, Zimbabwe.
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DOI：
10.1136/ebmental-2021-300317
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发表时间：
2022-05
影响因子：
5.2
通讯作者：
Araya, Ricardo
中科院分区：
文献类型：
--
作者：
Healey, Andrew;Verhey, Ruth;Mosweu, Iris;Boadu, Janet;Chibanda, Dixon;Chitiyo, Charmaine;Wagenaar, Brad;Senra, Hugo;Chiriseri, Ephraim;Mboweni, Sandra;Araya, Ricardo
任务分担治疗方法为治疗低收入和中等收入国家（LMIC）的常见精神障碍提供了一种务实的方法。津巴布韦开发的友谊长凳（FB）在其他中低收入国家越来越多地采用，是这种利用非专业卫生工作者提供治疗的治疗模式的一个例子。考虑津巴布韦最近扩大FB所需的治疗覆盖水平是否具有成本效益。在“成本效用”框架内使用推荐的成本效益阈值进行基于模型的确定性阈值分析。为确保增加服务的成本效益，食物及卫生局须额外诊治3413名服务使用者（每名活跃的长者健康院每年诊治10名使用者）。这假设了在临床试验条件下观察到的治疗效果水平。假设2020年报告的治疗覆盖水平，相关的增量成本效益比为每年191美元，避免了残疾。取得成本效益成果所需的治疗覆盖率在2020年观察到的治疗覆盖率水平范围内，即使假设治疗效果水平显著受损，也仍然如此。原则上，扩大FB交付的经济理由似乎令人信服，应认真考虑在LMIC环境中大规模采用FB。关于有可能提供有效和具有成本效益的手段维持所需治疗覆盖率的扩大战略类型的进一步证据，将有助于集中努力采取扩大战略的办法，优化投入任务分担方案的资源。
Task-sharing treatment approaches offer a pragmatic approach to treating common mental disorders in low-income and middle-income countries (LMICs). The Friendship Bench (FB), developed in Zimbabwe with increasing adoption in other LMICs, is one example of this type of treatment model using lay health workers (LHWs) to deliver treatment. To consider the level of treatment coverage required for a recent scale-up of the FB in Zimbabwe to be considered cost-effective. A modelling-based deterministic threshold analysis conducted within a ‘cost-utility’ framework using a recommended cost-effectiveness threshold. The FB would need to treat an additional 3413 service users (10 per active LHW per year) for its scale-up to be considered cost-effective. This assumes a level of treatment effect observed under clinical trial conditions. The associated incremental cost-effectiveness ratio was $191 per year lived with disability avoided, assuming treatment coverage levels reported during 2020. The required treatment coverage for a cost-effective outcome is within the level of treatment coverage observed during 2020 and remained so even when assuming significantly compromised levels of treatment effect. The economic case for a scaled-up delivery of the FB appears convincing in principle and its adoption at scale in LMIC settings should be given serious consideration. Further evidence on the types of scale-up strategies that are likely to offer an effective and cost-effective means of sustaining required levels of treatment coverage will help focus efforts on approaches to scale-up that optimise resources invested in task-sharing programmes.
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影响因子：
17.7
作者：
Araya, Ricardo;Flynn, Terry;Simon, Greg
通讯作者：
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影响因子：
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作者：
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影响因子：
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影响因子：
4.1
作者：
Ali, Shehzad;Rhodes, Laura;Delgadillo, Jaime
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DOI：
10.2471/blt.12.104133
发表时间：
2012-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
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通讯作者：
Patel, Vikram