Chisholm Dan, Lee Yong Yi, Baral Phanindra Prasad, Bhagwat Sadhana, Dombrovskiy Vladislav, Grafton Daniel, Kontsevaya Anna, Huque Rumana, Kalani Okware Kenneth, Kulikov Alexey, Marahatta Kedar, Mavunganidze Patience, Omar Nasri, Prasai Devi, Putoud Nadia, Tsoyi Elena, Vergara Jasmine
Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva, Switzerland.
Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Front Health Serv. 2023 Jul 18;3:1214885. doi: 10.3389/frhs.2023.1214885. eCollection 2023.
Despite the increasing interest in and political commitment to mental health service development in many regions of the world, there remains a very low level of financial commitment and corresponding investment. Assessment of the projected costs and benefits of scaling up the delivery of effective mental health interventions can help to promote, inform and guide greater investment in public mental health.
A series of national mental health investment case studies were carried out (in Bangladesh, Kenya, Nepal, Philippines, Uganda, Uzbekistan and Zimbabwe), using standardized guidance developed by WHO and UNDP and implemented by a multi-disciplinary team. Intervention costs and the monetized value of improved health and production were computed in national currency units and, for comparison, US dollars. Benefit-cost ratios were derived.
Across seven countries, the economic burden of mental health conditions was estimated at between 0.5%-1.0% of Gross Domestic Product. Delivery of an evidence-based package of mental health interventions was estimated to cost US$ 0.40-2.40 per capita per year, depending on the country and its scale-up period. For most conditions and country contexts there was a return of >1 for each dollar or unit of local currency invested (range: 0.0-10.6 to 1) when productivity gains alone are included, and >2 (range: 0.4-30.3 to 1) when the intrinsic economic value of health is also considered. There was considerable variation in benefit-cost ratios between intervention areas, with population-based preventive measures and treatment of common mental, neurological and conditions showing the most attractive returns when all assessed benefits are taken into account.
Performing a mental health investment case can provide national-level decision makers with new and contextualized information on the outlays and returns that can be expected from renewed local efforts to enhance access to quality mental health services. Economic evidence from seven low- and middle-income countries indicates that the economic burden of mental health conditions is high, the investment costs are low and the potential returns are substantial.
尽管世界许多地区对精神卫生服务发展的兴趣日益浓厚，且政治上也做出了承诺，但财政投入和相应投资水平仍然很低。评估扩大提供有效精神卫生干预措施的预计成本和效益有助于促进、告知并指导对公共精神卫生的更多投资。
利用世界卫生组织和联合国开发计划署制定并由一个多学科团队实施的标准化指南，开展了一系列国家精神卫生投资案例研究（在孟加拉国、肯尼亚、尼泊尔、菲律宾、乌干达、乌兹别克斯坦和津巴布韦）。干预成本以及改善健康和生产的货币化价值以本国货币单位计算，并为便于比较，换算为美元。得出了效益成本比。
在七个国家中，精神卫生状况的经济负担估计占国内生产总值的0.5%-1.0%。提供一套循证精神卫生干预措施估计每年人均成本为0.40-2.40美元，具体取决于国家及其扩大规模的时期。对于大多数情况和国家背景，仅计入生产力提高时，每投资1美元或当地货币单位的回报大于1（范围：0.0-10.6至1），同时考虑健康的内在经济价值时，回报大于2（范围：0.4-30.3至1）。各干预领域的效益成本比差异很大，当考虑所有评估效益时，基于人群的预防措施以及常见精神、神经疾病的治疗显示出最可观的回报。
开展精神卫生投资案例研究可为国家层面的决策者提供新的、基于具体情况的信息，说明当地为增加获得优质精神卫生服务的机会而做出新努力时可能产生的支出和回报。来自七个低收入和中等收入国家的经济证据表明，精神卫生状况的经济负担很高，投资成本很低，潜在回报很大。
