REVIEW ARTICLE Mental health economics: Insights from Brazil

Cruz, Luciane Nascimento; Lima, Ana Flavia Da Silva; Graeff-Martins, Ana Soledade; Maia, Carlos Renato Moreira; Ziegelmann, Patrícia Klarmann; Miguel, Sandoro; Fleck, Marcelo P.; Polanczyk, Carísi Anne

doi:10.3109/09638237.2012.759193

Cited by 9 publications

(4 citation statements)

References 26 publications

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“…It may sound incoherent that LMICs, which should be saving money, are probably those that are wasting it most. 39 Recent studies have pointed out the necessity of cost-effectiveness studies for LMICs, 40 but, to the best of our knowledge, the present work is the first to show an advantageous economic option for a chronic disease which can be treated with MPH-IR even in low-resource settings. 41 In addition, our study demonstrated that, in LMICs, investments in such analyses can reveal a favorable scenario in contrast with wealthy countries.…”

Section: Discussionmentioning

confidence: 74%

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Maia

Stella²,

Wagner

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

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Section: Discussionmentioning

confidence: 74%

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Maia

Stella²,

Wagner

et al. 2015

Rev. Bras. Psiquiatr.

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“…While we did not observe a relationship between SSRIs and prevalent CHD, we did observe a twofold increase association for SSRIs and coronary revascularization. A possible explanation for the null association between SSRIs and myocardial infarction is the restricted access to antidepressants from the SSRI class of antidepressants, resulting perhaps from the socioeconomic inequities of Brazilian mental health care ( 28 , 32 , 33 ) and high cost of these newer medications.…”

Section: Discussionmentioning

confidence: 99%

The Association between Antidepressant Medications and Coronary Heart Disease in Brazil: A Cross-Sectional Analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)

Kemp

Brunoni

Bittencourt

et al. 2015

Front. Public Health

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Background: Recent studies have highlighted associations between use of antidepressant medications and coronary heart disease (CHD). Tricyclic antidepressants (TCA) are not recommended in patients with CHD as they may increase morbidity and mortality. However, this class of antidepressants is freely prescribed in public health pharmacies, while access to other classes of antidepressants is restricted in Brazil. Here, we examine the associations between antidepressant use and prevalent CHD in a large cohort from Brazil.Methods: Participants included 14,994 civil servants aged 35–74 years from the baseline assessment of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (n = 710) included stable angina, myocardial infarction, and coronary revascularization. Univariate (unadjusted) and multivariate (adjusted) logistic regression analyses were conducted to estimate odds ratios and confidence intervals.Results: After full adjustment for covariates, TCA use (n = 156) was associated with a twofold increase in prevalent CHD, relative to non-use (n = 14,076). Additional sensitivity analysis revealed a threefold association for myocardial infarction (OR: 2.96, 95% CI: 1.41–6.21) and coronary revascularization (OR: 2.92, 95% CI: 1.28–6.66). There were no significant associations between antidepressant use and stable angina pectoris.Conclusion: Findings highlight a strong association between TCA use and prevalent CHD. While the cross-sectional design is an important limitation of the present study, findings have important implications for the treatment of cardiac patients in Brazil.

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“…Many aspirational global goals have strong interdependencies with mental health, for example; peaceful and inclusive societies (Goodwin & Rona, 2013) and safety in human settlements (Ouanes et al, 2014), sustainable economic growth (Cruz et al, 2013) and productive employment (Katikireddi et al, 2012), inclusive education and learning opportunities, food security and improved nutrition (Surkan et al, 2011), maternal and child health, healthy lives and well-being, the overall population level (Guszkowska et al, 2014), and a more equal society.…”

Section: Mental Health Presents Cross-cutting Issues For Health and Dmentioning

confidence: 99%

The importance of global mental health for the Sustainable Development Goals

Votruba

Eaton²,

Prince

et al. 2014

Journal of Mental Health

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REVIEW ARTICLE Mental health economics: Insights from Brazil

Cited by 9 publications

References 26 publications

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

The Association between Antidepressant Medications and Coronary Heart Disease in Brazil: A Cross-Sectional Analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)

The importance of global mental health for the Sustainable Development Goals

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