Background: Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy.
Methods: A methodology of extended cost-effectiveness analysis (ECEA) is applied to a parent contextualized cost-effectiveness analysis of MN health care in Ethiopia. Impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive
case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy), and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact.
Results: The MN package is expected to cost US$177 million and avert 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. Health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. A 78% overall rate of return to investment is expected from depression treatment in Ethiopia due to productivity gains (equals to US$50.7m annually).
Conclusions: The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The ECEA approach seems to fit well with the current policy challenges and captures important equity concerns of scaling up MN programs.
Johansson KA, Strand KB, Fekadu A, Chisholm D. 2015. Health Gains and Financial Risk Protection Provided by the Ethiopian Mental Health Strategy. DCP3 Working Paper Series. No 16.