Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile.
King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Centre, London, UK.
Epidemiol Psychiatr Sci. 2024 Apr 5;33:e21. doi: 10.1017/S2045796024000222.
The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil.
A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in São Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results.
The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses.
This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.
在高收入国家，精神病早期干预（EIP）服务的有效性和成本效益已得到充分证实，但在中低收入国家（LMICs）却并非如此。尽管当地证据稀缺，但在 LMICs 已经实施了几种 EIP 服务。在 LMICs 采用专业护理模式之前，需要进行当地评估。我们旨在评估在巴西实施 EIP 服务的成本效益。
从巴西医疗保健系统的角度，对 EIP 服务进行基于模型的经济评估。使用在圣保罗进行的队列研究开发了一个马尔可夫模型。成本数据从当地来源获取。结果是增量成本效益比（ICER），以增量质量调整生命年（QALY）的增量成本来衡量。进行敏感性分析以检验结果的稳健性。
该研究纳入了 357 名参与者（38%为女性），平均年龄（标准差）为 26（7.38）岁。根据模型，在巴西实施 EIP 服务将导致平均增量成本为 4478 巴西雷亚尔（R$）和平均增量效益为 0.29 QALY。增量成本效益比为 15495 雷亚尔（经购买力平价调整后的 7640 美元）每 QALY，可以被认为是具有成本效益的，在支付意愿阈值为 1 人均国内生产总值（R$ 18254；经购买力平价调整后的 9000 美元）时。模型结果对敏感性分析具有稳健性。
本研究支持在巴西实施 EIP 服务的经济优势。尽管需要进行文化适应，但这些数据表明，即使在资源较少的国家，EIP 服务也可能具有成本效益。
