Cost-effectiveness of interventions for severe mental illness in low and middle-income countries (LMICs); a...

Severe mental illness (SMI) is a major contributor to disease burden in low- and middle-income countries (LMICs), where over 80% of people with mental illness live. Yet evidence on cost-effective interventions remains scarce. This review examined the cost-effectiveness of SMI interventions in LMICs. A systematic search was conducted in Medline, CINAHL, APA PsycINFO, Embase, Cochrane Central, and Global Index Medicus. Eligible studies reported cost-effectiveness of SMI interventions. Data was extracted based on Joanna Briggs Institute (JBI) economic evaluation form, and quality was assessed with ECOBIAS (Bias in Economic Evaluation) and JBI tools. Due to methodological heterogeneity, findings were narratively synthesized. From 6,905 records, 20 studies met inclusion. Most (17/20) used economic models, often Markov model. In upper middle-income countries, atypical antipsychotics with psychoeducation were cost-effective below US$ 25,000 per quality adjusted life year [QALY]. In lower middle-income countries, Olanzapine or Risperidone combined with family therapy were cost-effective at willingness-to-pay (WTP) thresholds ranging from US$ 547 per disability adjusted life year [DALY] to US$ 2,350 per QALY. However, these conclusions may change under more conservative WTP thresholds. Variation in model structure, analytical perspective, and time horizon may further limit the generalizability of the findings.