Burden of disease: Costing an effective package of care for mental disorders

世卫组织-世界银行-哈佛大学合作的全球疾病负担项目展示了发达国家和发展中国家全球卫生状况的前所未有的图景，为规划卫生服务提供了急需的信息。健康是在人口水平上衡量的，并结合因死亡和残疾而损失的寿命年数，得出每个疾病损失的生命总量。该项目的一个令人惊讶的地方是精神障碍的重要性，在澳大利亚等国家，精神障碍占因残疾而损失的寿命年的43%。减少这一负担的服务规划需要了解具有成本效益的治疗方法。这项计划将试验一种用于结合负担和成本效益数据的方法，以设计一套基本的服务，以解决精神障碍的治疗短缺问题。这项研究将有助于我们理解为什么精神障碍造成的负担仍然存在，以及目前的治疗知识在多大程度上能够在现有预算限制的范围内解决这一负担。这将通过以下方式实现：1)详细说明澳大利亚目前为精神障碍提供的服务的成本和人群结果，以确定哪些疾病目前已得到充分治疗，哪些疾病需要进一步干预；2)根据临床实践指南计算最佳实践干预的成本和结果，以了解目前的治疗知识可以在多大程度上减轻因精神障碍造成的负担；3)检查这样一套理想干预措施的公平后果，了解治疗终点并不适用于所有疾病。这是一个二次分析，代表了一种将个别治疗的现有成本和结果数据转化为其在人口一级的卫生规划的成本和后果的方法。

The Global Burden of Disease project, a WHO-World Bank-Harvard collaboration, presented an unprecedented picture of global health across the developed and developing world, providing much-needed information for planning health services. Health was measured at the population level, and combined the number of life years lost due to death and disablement to give a total amount of life lost per disorder. One surprise of the project was the importance of mental disorders, accounting for 43% of life years lost due to disability in countries like Australia. Service planning to reduce this burden requires knowledge of cost-effective treatments.This project will trial a method used for combining burden and cost-effectiveness data to design an essential package of services to address the treatment shortfall in mental disorders. This research will assist in our understanding of why burden due to mental disorders persists, and the extent to which current treatment knowledge is able to address this burden within existing budgetary constraints. This will be achieved by: 1) detailing the costs and population outcome of current services in Australia for mental disorders, to determine which disorders are currently adequately treated and which disorders require further intervention, 2) calculating the costs and outcome of best practice interventions from clinical practice guidelines, to understand the extent to which current treatment knowledge can reduce burden due to mental disorders, 3) examining the equity consequences of such a package of ideal interventions, with the understanding that the treatment endpoint is not the same for all disorders. This is a secondary analysis, representing a method for translating existing cost and outcome data for individual treatments into their costs and consequences for health planning at the population level.