The impact of obesity on health care costs among persons with schizophrenia

Obesity is the second leading cause of preventable death in the US, and is twice as common among individuals with schizophrenia as the general population

Collaborative Care for Mental Health in Low- and Middle-Income Countries: A WHO Health Systems Framework Assessment of Three Programs

The collaborative care model is an evidence-based intervention for behavioral and other chronic conditions that has the potential to address the large burden of mental illness globally. Using the World Health Organization Health Systems Framework, the authors present challenges in implementing this model in low- and middle-income countries (LMICs) and discuss strategies to address these challenges based on experiences with three large-scale programs: an implementation research study in a district-level government hospital in rural Nepal, one clinical trial in 50 primary health centers in rural India, and one study in four diabetes clinics in India. Several strategies can be utilized to address implementation challenges and enhance scalability in LMICs, including mobilizing community resources, engaging in advocacy, and strengthening the overall health care delivery system

Collaborative Care for Mental Health in Low- and Middle-Income Countries: A WHO Health Systems Framework Assessment of Three Programs

The collaborative care model is an evidence-based intervention for behavioral and other chronic conditions that has the potential to address the large burden of mental illness globally. Using the World Health Organization Health Systems Framework, the authors present challenges in implementing this model in low- and middle-income countries (LMICs) and discuss strategies to address these challenges based on experiences with three large-scale programs: an implementation research study in a district-level government hospital in rural Nepal, one clinical trial in 50 primary health centers in rural India, and one study in four diabetes clinics in India. Several strategies can be utilized to address implementation challenges and enhance scalability in LMICs, including mobilizing community resources, engaging in advocacy, and strengthening the overall health care delivery system

Cost-effectiveness of a collaborative care model among patients with type 2 diabetes and depression in India

   Objective To assess the cost-effectiveness of collaborative versus usual care in adults with poorly-controlled type 2 diabetes and depression in India. Research Design and Methods We performed a within-trial cost-effectiveness analysis of a 24-month parallel, open-label, pragmatic randomized clinical trial at four urban clinics in India from multipayer and societal perspectives. The trial randomized 404 patients with poorly-controlled type 2 diabetes (HbA1c≥8.0% or systolic BP≥140mmHg or LDL-c≥130mg/dl) and depressive symptoms (PHQ-9≥10) to collaborative care (support from non-physician care coordinators, electronic registers, and specialist-supported case review) for 12 months, followed by 12 months usual care or 24 months usual care. We calculated incremental cost-effectiveness ratios (ICER) in Indian rupees (INR) and international dollars (Int’l) and the probability of cost-effectiveness using quality-adjusted life years (QALYs) and depression-free days (DFDs). Results From a multipayer perspective, collaborative care costed additional INR309,558 (Int’l-$15,344) per QALY and additional INR290.2 (Int’l-$14.4) per DFD gained compared to usual care. The probability of cost-effectiveness was 56.4% using a willingness-to-pay of INR336,000 (Int’l-$16,654) per QALY (~3-times per-capita GDP). The willingness-to-pay per DFD to achieve a probability of cost-effectiveness >95$ 19.9). From a societal perspective, cost-effectiveness was marginally lower. In sensitivity analyses, integrating collaborative care in clinical workflows reduced incremental costs by ~47% (ICER: 162,689/QALY; cost-effectiveness probability: 89.4%) but cost-effectiveness decreased when adjusting for baseline values. Conclusions Collaborative care for patients with type 2 diabetes and depression in urban India can be cost-effective, especially when integrated in clinical workflows. Long-term cost-effectiveness might be more favorable. Scalability across lower- and middle-income country settings depends on heterogeneous contextual factors. </p