Cost-effectiveness of WHO Problem Management Plus for adults with mood and anxiety disorders in a post-conflict area of Pakistan: randomised controlled trial.



Hamdani, Syed Usman, Huma, Zill-E- ORCID: 0000-0002-2681-1771, Rahman, Atif ORCID: 0000-0002-2066-4467, Wang, Duolao, Chen, Tao ORCID: 0000-0002-5489-6450, van Ommeren, Mark, Chisholm, Dan and Farooq, Saeed
(2020) Cost-effectiveness of WHO Problem Management Plus for adults with mood and anxiety disorders in a post-conflict area of Pakistan: randomised controlled trial. The British journal of psychiatry : the journal of mental science, 217 (5). pp. 623-629.

Access the full-text of this item by clicking on the Open Access link.
[img] Other
PDF_Proof (1).PDF - Author Accepted Manuscript

Download (802kB) | Preview

Abstract

BACKGROUND:With the development of evidence-based interventions for treatment of priority mental health conditions in humanitarian settings, it is important to establish the cost-effectiveness of such interventions to enable their scale-up. AIMS:To evaluate the cost-effectiveness of the Problem Management Plus (PM+) intervention compared with enhanced usual care (EUC) for common mental disorders in primary healthcare in Peshawar, Pakistan. Trial registration ACTRN12614001235695 (anzctr.org.au). METHOD:We randomly allocated 346 participants to either PM+ (n = 172) or EUC (n = 174). Effectiveness was measured using the Hospital Anxiety and Depression Scale (HADS) at 3 months post-intervention. Cost-effectiveness analysis was performed as incremental costs (measured in Pakistani rupees, PKR) per unit change in anxiety, depression and functioning scores. RESULTS:The total cost of delivering PM+ per participant was estimated at PKR 16 967 (US$163.14) using an international trainer and supervisor, and PKR 3645 (US$35.04) employing a local trainer. The mean cost per unit score improvement in anxiety and depression symptoms on the HADS was PKR 2957 (95% CI 2262-4029) (US$28) with an international trainer/supervisor and PKR 588 (95% CI 434-820) (US$6) with a local trainer/supervisor. The mean incremental cost-effectiveness ratio (ICER) to successfully treat a case of depression (PHQ-9 ≥ 10) using an international supervisor was PKR 53 770 (95% CI 39 394-77 399) (US$517), compared with PKR 10 705 (95% CI 7731-15 627) (US$102.93) using a local supervisor. CONCLUSIONS:The PM+ intervention was more effective but also more costly than EUC in reducing symptoms of anxiety, depression and improving functioning in adults impaired by psychological distress in a post-conflict setting of Pakistan.

Item Type: Article
Uncontrolled Keywords: Cost-effectiveness, lay health worker, humanitarian setting, Problem Management Plus, common mental disorder (CMD)
Depositing User: Symplectic Admin
Date Deposited: 21 Sep 2020 13:24
Last Modified: 18 Jan 2023 23:38
DOI: 10.1192/bjp.2020.138
Open Access URL: http://archive.lstmed.ac.uk/15423/
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3095791