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

世卫组织-世界银行-哈佛大学合作开展的全球疾病负担项目，展示了发达国家和发展中国家前所未有的全球卫生状况，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生命年数，得出每种疾病损失的生命总数。该项目的一个惊喜是精神障碍的重要性，在澳大利亚等国家，由于残疾而损失的生命年占43%。为减轻这一负担而进行的服务规划需要了解具有成本效益的治疗方法，本项目将试验一种将负担和成本效益数据相结合的方法，以设计一套基本服务，解决精神障碍治疗不足的问题。这项研究将有助于我们理解为什么精神障碍造成的负担持续存在，以及在现有的预算限制下，目前的治疗知识能够在多大程度上解决这一负担。这将通过以下方式实现：1）详细说明澳大利亚目前精神障碍服务的成本和人口结果，以确定哪些疾病目前得到充分治疗，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，以了解当前治疗知识可以在多大程度上减轻精神障碍造成的负担，3）检查这种一揽子理想干预措施的公平后果，并了解治疗终点对所有疾病都不相同。这是一种二次分析，代表了一种将现有的个别治疗费用和结果数据转化为人口一级卫生规划费用和后果的方法。

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.