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EminentPanelConference,Accra,August7th -9th,2020
PRELIMINARY FINDINGS:
BENEFIT-COST ANALYSIS OF MENTAL HEALTH
INTERVENTIONS IN GHANA
Justice Nonvignon, PhD
Associate Professor
School of Public Health
University of Ghana
Context
• About 13% of approximately 30 million people in Ghana suffer from a
mental disorder.
 3% suffer from severe mental disorder; 10% suffer from moderate to mild mental
disorder
• The treatment gap for mental health disorders in Ghana is estimated to
be more than 98% (WHO, 2007).
- Inadequate mental health specialists, primary care physicians
- Little training in mental health—only about 3% of entire training
- Inadequate infrastructure – three specialized hospitals
• Global economic cost of mental illness
- Est. at $2.5 trillion, projected to increase to $6 trillion by 2030
- Low investment in mental health (less than 1% of the health budget in many countries)
BENEFIT-COST ANALYSIS OF MENTAL
HEALTH INTERVENTIONS IN GHANA
Background
• Intervention 1: Screening and Treatment of Depression
- About 13,202 people (40% of the pop with depression) projected to
receive treatment
- A projected 30% (3,961) treatment recipients to remain on
antidepressants for life.
• Intervention 2: Screening and Treatment of Anxiety Disorders
- About 11,362 (40% of the pop with condition) people projected to
receive treatment
- A projected 30% (3,409) treatment recipients to remain on
antidepressants for life.
• Intervention 3: Screening and Treatment of Schizophrenia
- About 667 people (40% of the pop with disease) projected to receive
treatment
- Schizophrenia patients receive treatment for life
Screening and treatment of depression would cost GHS 110.3m
for 13,202 cases within a period of 10 years without discounting
Target population
• 13,202 depression cases (30% to remain of anti-
depressant for life)
Treatment duration
10 years
Costs = 110.3m cedi (undiscounted cost est.)
• Direct medical cost of depression screening and
treatment is 42.3m cedi (38.3% of total cost)
• Direct non-medical cost of depression screening
and treatment is 50.2m cedi (45.5% of total cost)
• Indirect cost of depression screening and
treatment is 17.9m cedi (16.2% of total cost)
38.3%
45.5%
16.2%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Percent
(%)
Cost of depression screening and
treatment
Direct medical cost Direct non-medical cost
Indirect cost
Benefits through the impact of a depression programme
• The total expected benefits through
the impact of a depression programme
on employment is estimated at GHS
948m (undiscounted cost est.)
- Benefits in terms of patient productivity
loss est. at GHS565m
- Caregiver’s benefits derived from
caregiver productivity loss est. at GHS
271m
- Benefits from averted self-harm est. at
GHS23m.
- Benefits from averted suicide est. at
GHS87m.
437
380
295
210
182
142
18 16 12
66 57 43
0
50
100
150
200
250
300
350
400
450
500
5% 8% 14% 5% 8% 14% 5% 8% 14% 5% 8% 14%
Patient Caregiver Averted self-harm Averted suicide
GHS
(million)
Benefits of mental health programmes for
depression (Discounted at 5%,8% & 14%)
Screening and treatment of anxiety disorders would cost GHS
108.3m for 11,362 cases within a period of 10 years without
disc.
Target population
• 11,362 anxiety disorder cases (30% to remain of
anti-depressant for life)
Treatment duration
10 years
Costs = 110.3m cedi (undiscounted cost est.)
• Direct medical cost of depression screening and
treatment is 42.8m cedi (39.6% of total cost)
• Direct non-medical cost of depression screening
and treatment is 43.2m cedi (39.8% of total cost)
• Indirect cost of depression screening and
treatment is 22.3m cedi (20.6% of total cost)
39.6%
39.8%
20.6%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Percent
(%)
Cost of anxiety disorder screening and
treatment
Direct medical cost Direct non-medical cost
Indirect cost
Benefits through the impact of an anxiety disorder
programme
• The total expected benefits through
the impact of an anxiety disorder
programme on employment is
estimated at GHS 610m (undiscounted
cost est.)
- Benefits in terms of patient productivity
loss est. at GHS292m
- Caregiver’s benefits derived from
caregiver productivity loss est. at GHS
292m
- Benefits from averted self-harm est. at
GHS20m.
- Benefits from averted suicide est. at
GHS63m.
226
196
152
180
157
122
16 14 11
64
48
31
0
50
100
150
200
250
5% 8% 14% 5% 8% 14% 5% 8% 14% 5% 8% 14%
Patient Caregiver Averted self-
harm
Averted suicide
GHS
(million)
Benefits of mental health programmes for anxiety
disorder (Discounted at 5%,8% & 14%)
Screening and treatment of Schizophrenia would cost GHS 36m
for 667 cases within a period of 10 years without discounting
Target population
• 667 schizophrenia cases (schizophrenia patients
receive treatment for life)
Treatment duration
10 years
Costs = 36m cedi (undiscounted cost est.)
• Direct medical cost of depression screening and
treatment is 22.8m cedi (63.2% of total cost)
• Direct non-medical cost of depression screening
and treatment is 8.7m cedi (24.3% of total cost)
• Indirect cost of depression screening and
treatment is 4.5m cedi (12.5% of total cost)
63.2%
24.3%
12.5%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Percent
(%)
Cost of Schizophrenia screening and
treatment
Direct medical cost Direct non-medical cost
Indirect cost
Benefits through the impact of a Schizophrenia programme
• The total expected benefits through
the impact of a schizophrenia
programme on employment is
estimated at GHS66m (undiscounted
cost est.)
- Benefits in terms of patient productivity
loss est. at GHS43m
- Caregiver’s benefits derived from
caregiver productivity loss est. at GHS
17m
- Benefits from averted self-harm est. at
GHS1m.
- Benefits from averted suicide est. at
GHS4m.
33
29
23
13 12
9
0.8 0.7 0.5
4 3 2
0
5
10
15
20
25
30
35
5% 8% 14% 5% 8% 14% 5% 8% 14% 5% 8% 14%
Patient Caregiver Averted self-
harm
Averted suicide
GHS
(million)
Benefits of mental health programmes for
Schizophrenia (Discounted at 5%,8% & 14%)
Benefit-Cost Ratios
Intervention Discount Rate Benefit (GHS) Cost (GHS) BCR
Screening and treatment of
depression
5% 730,795,144 98,225,804 7.44
8% 634,391,228 92,280,154 6.87
14% 492,208,467 82,500,105 5.97
Screening and treatment of
anxiety disorder
5% 470,121,071 95,082,579 4.94
8% 408,038,877 88,672,075 4.6
14% 316,493,509 78,315,503 4.04
Screening and treatment of
schizophrenia
5% 51,061,090 30,681,547 1.66
8% 44,337,108 28,220,054 1.57
14% 34,416,996 24,428,619 1.41

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Ghana Priorities: Mental Health

  • 1. EminentPanelConference,Accra,August7th -9th,2020 PRELIMINARY FINDINGS: BENEFIT-COST ANALYSIS OF MENTAL HEALTH INTERVENTIONS IN GHANA Justice Nonvignon, PhD Associate Professor School of Public Health University of Ghana
  • 2. Context • About 13% of approximately 30 million people in Ghana suffer from a mental disorder.  3% suffer from severe mental disorder; 10% suffer from moderate to mild mental disorder • The treatment gap for mental health disorders in Ghana is estimated to be more than 98% (WHO, 2007). - Inadequate mental health specialists, primary care physicians - Little training in mental health—only about 3% of entire training - Inadequate infrastructure – three specialized hospitals • Global economic cost of mental illness - Est. at $2.5 trillion, projected to increase to $6 trillion by 2030 - Low investment in mental health (less than 1% of the health budget in many countries)
  • 3. BENEFIT-COST ANALYSIS OF MENTAL HEALTH INTERVENTIONS IN GHANA
  • 4. Background • Intervention 1: Screening and Treatment of Depression - About 13,202 people (40% of the pop with depression) projected to receive treatment - A projected 30% (3,961) treatment recipients to remain on antidepressants for life. • Intervention 2: Screening and Treatment of Anxiety Disorders - About 11,362 (40% of the pop with condition) people projected to receive treatment - A projected 30% (3,409) treatment recipients to remain on antidepressants for life. • Intervention 3: Screening and Treatment of Schizophrenia - About 667 people (40% of the pop with disease) projected to receive treatment - Schizophrenia patients receive treatment for life
  • 5. Screening and treatment of depression would cost GHS 110.3m for 13,202 cases within a period of 10 years without discounting Target population • 13,202 depression cases (30% to remain of anti- depressant for life) Treatment duration 10 years Costs = 110.3m cedi (undiscounted cost est.) • Direct medical cost of depression screening and treatment is 42.3m cedi (38.3% of total cost) • Direct non-medical cost of depression screening and treatment is 50.2m cedi (45.5% of total cost) • Indirect cost of depression screening and treatment is 17.9m cedi (16.2% of total cost) 38.3% 45.5% 16.2% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Percent (%) Cost of depression screening and treatment Direct medical cost Direct non-medical cost Indirect cost
  • 6. Benefits through the impact of a depression programme • The total expected benefits through the impact of a depression programme on employment is estimated at GHS 948m (undiscounted cost est.) - Benefits in terms of patient productivity loss est. at GHS565m - Caregiver’s benefits derived from caregiver productivity loss est. at GHS 271m - Benefits from averted self-harm est. at GHS23m. - Benefits from averted suicide est. at GHS87m. 437 380 295 210 182 142 18 16 12 66 57 43 0 50 100 150 200 250 300 350 400 450 500 5% 8% 14% 5% 8% 14% 5% 8% 14% 5% 8% 14% Patient Caregiver Averted self-harm Averted suicide GHS (million) Benefits of mental health programmes for depression (Discounted at 5%,8% & 14%)
  • 7. Screening and treatment of anxiety disorders would cost GHS 108.3m for 11,362 cases within a period of 10 years without disc. Target population • 11,362 anxiety disorder cases (30% to remain of anti-depressant for life) Treatment duration 10 years Costs = 110.3m cedi (undiscounted cost est.) • Direct medical cost of depression screening and treatment is 42.8m cedi (39.6% of total cost) • Direct non-medical cost of depression screening and treatment is 43.2m cedi (39.8% of total cost) • Indirect cost of depression screening and treatment is 22.3m cedi (20.6% of total cost) 39.6% 39.8% 20.6% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Percent (%) Cost of anxiety disorder screening and treatment Direct medical cost Direct non-medical cost Indirect cost
  • 8. Benefits through the impact of an anxiety disorder programme • The total expected benefits through the impact of an anxiety disorder programme on employment is estimated at GHS 610m (undiscounted cost est.) - Benefits in terms of patient productivity loss est. at GHS292m - Caregiver’s benefits derived from caregiver productivity loss est. at GHS 292m - Benefits from averted self-harm est. at GHS20m. - Benefits from averted suicide est. at GHS63m. 226 196 152 180 157 122 16 14 11 64 48 31 0 50 100 150 200 250 5% 8% 14% 5% 8% 14% 5% 8% 14% 5% 8% 14% Patient Caregiver Averted self- harm Averted suicide GHS (million) Benefits of mental health programmes for anxiety disorder (Discounted at 5%,8% & 14%)
  • 9. Screening and treatment of Schizophrenia would cost GHS 36m for 667 cases within a period of 10 years without discounting Target population • 667 schizophrenia cases (schizophrenia patients receive treatment for life) Treatment duration 10 years Costs = 36m cedi (undiscounted cost est.) • Direct medical cost of depression screening and treatment is 22.8m cedi (63.2% of total cost) • Direct non-medical cost of depression screening and treatment is 8.7m cedi (24.3% of total cost) • Indirect cost of depression screening and treatment is 4.5m cedi (12.5% of total cost) 63.2% 24.3% 12.5% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Percent (%) Cost of Schizophrenia screening and treatment Direct medical cost Direct non-medical cost Indirect cost
  • 10. Benefits through the impact of a Schizophrenia programme • The total expected benefits through the impact of a schizophrenia programme on employment is estimated at GHS66m (undiscounted cost est.) - Benefits in terms of patient productivity loss est. at GHS43m - Caregiver’s benefits derived from caregiver productivity loss est. at GHS 17m - Benefits from averted self-harm est. at GHS1m. - Benefits from averted suicide est. at GHS4m. 33 29 23 13 12 9 0.8 0.7 0.5 4 3 2 0 5 10 15 20 25 30 35 5% 8% 14% 5% 8% 14% 5% 8% 14% 5% 8% 14% Patient Caregiver Averted self- harm Averted suicide GHS (million) Benefits of mental health programmes for Schizophrenia (Discounted at 5%,8% & 14%)
  • 11. Benefit-Cost Ratios Intervention Discount Rate Benefit (GHS) Cost (GHS) BCR Screening and treatment of depression 5% 730,795,144 98,225,804 7.44 8% 634,391,228 92,280,154 6.87 14% 492,208,467 82,500,105 5.97 Screening and treatment of anxiety disorder 5% 470,121,071 95,082,579 4.94 8% 408,038,877 88,672,075 4.6 14% 316,493,509 78,315,503 4.04 Screening and treatment of schizophrenia 5% 51,061,090 30,681,547 1.66 8% 44,337,108 28,220,054 1.57 14% 34,416,996 24,428,619 1.41