Hamdani, SU, Huma, Z-E, Rahman, A, Wang, D, Chen, T, van Ommeren, M, Chisholm, D and Farooq, S (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. British Journal of Psychiatry, 217 (5). pp. 623-629. ISSN 1472-1465

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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
Additional Information: © The Authors, 2020. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. All relevant information related to this article can be found at; https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/costeffectiveness-of-who-problem-management-plus-for-adults-with-mood-and-anxiety-disorders-in-a-postconflict-area-of-pakistan-randomised-controlled-trial/DFC9D4AFFCE234389592DA5C1548DD41
Uncontrolled Keywords: Cost-effectiveness; lay health worker; humanitarian setting; Problem Management Plus; common mental disorder (CMD)
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RC Internal medicine > RC435 Psychiatry
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 10 Aug 2020 14:47
Last Modified: 28 Jan 2021 01:30
URI: https://eprints.keele.ac.uk/id/eprint/8526

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