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Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study

BMJ 2012; 344 doi: (Published 02 March 2012) Cite this as: BMJ 2012;344:e609
  1. Dan Chisholm, health economist12,
  2. Shekhar Saxena, director2
  1. 1Department of Health Systems Financing, World Health Organization, 1211 Geneva, Switzerland
  2. 2Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  1. Correspondence to: D Chisholm chisholmd{at}
  • Accepted 10 October 2011


Objective To assess the comparative costs and effects of interventions to combat five neuropsychiatric conditions (schizophrenia, bipolar disorder, depression, epilepsy, and heavy alcohol use).

Design Cost effectiveness analysis based on an epidemiological model.

Setting Two epidemiologically defined World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD).

Data sources Published studies, costing databases.

Main outcome measures Cost per capita and cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005.

Results Across 44 assessed intervention strategies for the five neuropsychiatric conditions, cost effectiveness values differed by as much as two orders of magnitude (from $Int100–250 to $Int10 000–25 000 for a year of healthy life gained). In both sub-regions, inpatient based treatment of schizophrenia with newer antipsychotic drugs was the most costly and least cost effective strategy. The most cost effective strategies in the African sub-region related to population based alcohol control, while in the South East Asian sub-region the most cost effective intervention was drug treatment of epilepsy in primary care. The cumulative cost per capita of the most cost effective set of interventions covering all five conditions was estimated at $Int4.90–5.70. This package comprises interventions for epilepsy (older first line antiepileptic drugs); depression (generically produced newer antidepressants and psychosocial treatment); bipolar disorder (mood stabiliser drug lithium); schizophrenia (neuroleptic antipsychotic drugs and psychosocial treatment); and heavy alcohol use (increased taxation and its enforcement, reduced access, and, in the African sub-region, advertising bans and brief advice to heavy drinkers in primary care).

Conclusions Reallocation of resources to cost effective intervention strategies would increase health gain, save money and help implement much needed expansion of services for neuropsychiatric conditions in low resource settings.


  • doi: 10.1136/bmj.e586
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  • We thank Dr Mark van Ommeren for helpful comments on an earlier draft of this manuscript.

  • Contributors: DC designed the study, undertook the analysis, and drafted the paper. SS participated in the study design and interpretation of results and provided comments on the draft. DC is guarantor for the validity of the study results.

  • Funding: No external funding or sponsorship.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • The authors are staff members of the WHO. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the WHO.

  • Ethical approval: Not required.

  • Data sharing: No additional data available

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