The Use of Cost-Effectiveness Thresholds for Evaluating Health Interventions in Low- and Middle-Income Countries From 2015 to 2020: A Review

Background An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. Objective This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). Methods We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. Results In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. Conclusions Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

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Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview (Preprint)

10.2196/preprints.25847 ◽

2020 ◽

Author(s):

Susanna Lehtimaki ◽

Jana Martic ◽

Brian Wahl ◽

Katherine T Foster ◽

Nina Schwalbe

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Young People ◽

Digital Health ◽

Health Interventions ◽

Middle Income ◽

Middle Income Countries ◽

Mental Health Interventions ◽

Meta Analyses ◽

Low And Middle Income

BACKGROUND An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. OBJECTIVE This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). METHODS We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. RESULTS In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. CONCLUSIONS Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

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Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness

PLoS ONE ◽

10.1371/journal.pone.0182951 ◽

2017 ◽

Vol 12 (8) ◽

pp. e0182951 ◽

Cited By ~ 28

Author(s):

Susan Horton ◽

Hellen Gelband ◽

Dean Jamison ◽

Carol Levin ◽

Rachel Nugent ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Interventions ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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COST-EFFECTIVENESS OF PNEUMOCOCCAL CONJUGATE VACCINE (PCV) IN 94 LOW-AND MIDDLE-INCOME COUNTRIES, 2011-2020

10.26226/morressier.5731f0d2d462b8029237fede ◽

2016 ◽

Author(s):

Grace Morgan

Keyword(s):

Cost Effectiveness ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Evaluating the cost-effectiveness of maternal pertussis immunization in low- and middle-income countries: A review of lessons learnt

Vaccine ◽

10.1016/j.vaccine.2020.10.054 ◽

2021 ◽

Vol 39 (1) ◽

pp. 121-124 ◽

Cited By ~ 1

Author(s):

Louise B. Russell ◽

Ajoke Sobanjo-ter Meulen ◽

Cristiana M. Toscano

Keyword(s):

Cost Effectiveness ◽

Middle Income ◽

Middle Income Countries ◽

Lessons Learnt ◽

The Cost ◽

Low And Middle Income

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Payment‐by‐Results for health interventions in low‐ and middle‐income countries: A critical review

Development Policy Review ◽

10.1111/dpr.12538 ◽

2020 ◽

Author(s):

Maren Duvendack

Keyword(s):

Critical Review ◽

Health Interventions ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Designing the next generation of implementation research training for learners in low- and middle-income countries

Globalization and Health ◽

10.1186/s12992-021-00714-3 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Michael J. Penkunas ◽

Shiau Yun Chong ◽

Emma L. M. Rhule ◽

Evangelia Berdou ◽

Pascale Allotey

Keyword(s):

Implementation Research ◽

Research Training ◽

Training Model ◽

Learning By Doing ◽

Health Interventions ◽

System Level ◽

High Quality Research ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

AbstractEfficacious health interventions tested through controlled trials often fail to show desired impacts when implemented at scale. These challenges can be particularly pervasive in low- and middle-income settings where health systems often lack the capacity and mechanisms required for high-quality research and evidence translation. Implementation research is a powerful tool for identifying and addressing the bottlenecks impeding the success of proven health interventions. Implementation research training initiatives, although growing in number, remain out of reach for many investigators in low- and middle-income settings, who possess the knowledge required to contextualize challenges and potential solutions in light of interacting community- and system-level features. We propose a realigned implementation research training model that centers on team-based learning, tailored didactic opportunities, learning-by-doing, and mentorship.

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Are low and middle-income countries prioritising high-value healthcare interventions?

BMJ Global Health ◽

10.1136/bmjgh-2019-001850 ◽

2020 ◽

Vol 5 (2) ◽

pp. e001850

Author(s):

Ashley A Leech ◽

David D Kim ◽

Joshua T Cohen ◽

Peter J Neumann

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

National Health ◽

Sub Saharan Africa ◽

Health Plans ◽

Middle Income ◽

Middle Income Countries ◽

Health Priority ◽

Sub Saharan ◽

Low And Middle Income

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.MethodsWe used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008–2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.ResultsWe identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.ConclusionOur findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.

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