1
|
Aceituno D, Razzouk D, Jin H, Pennington M, Gadelha A, Bressan R, Noto C, Crossley N, Prina M. Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil. Epidemiol Psychiatr Sci 2024; 33:e21. [PMID: 38576239 PMCID: PMC11022262 DOI: 10.1017/s2045796024000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/16/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
AIMS The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil. METHODS A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in São Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results. RESULTS The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses. CONCLUSIONS This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.
Collapse
Affiliation(s)
- D. Aceituno
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, David Goldberg Centre, London, UK
- Mental Health Service, Complejo Asistencial Dr. Sotero del Rio, Puente Alto, Chile
| | - D. Razzouk
- Centre of Mental Health Economics, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - H. Jin
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, David Goldberg Centre, London, UK
| | - M. Pennington
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, David Goldberg Centre, London, UK
| | - A. Gadelha
- Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - R. Bressan
- Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - C. Noto
- Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - N. Crossley
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M. Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | | |
Collapse
|
3
|
Mitchell C, Sherman L, Nielsen S, Nelson P, Trumbo P, Hodges T, Hasegawa P, Bressan R, Ladisch M, Auslander D. Earth benefits of interdisciplinary CELSS-related research by the NSCORT in Bioregenerative Life Support. Adv Space Res 1996; 18:23-31. [PMID: 11538802 DOI: 10.1016/0273-1177(95)00858-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Earth benefits of research from the NSCORT in Bioregenerative Life Support will include the following: development of active control mechanisms for light, CO2, and temperature to maximize photosynthesis of crop plants during important phases of crop development; automation of crop culture systems; creation of novel culture systems for optimum productivity; creation of value-added crops with superior nutritional, yield, and waste-process characteristics; environmental control of food and toxicant composition of crops; new process technologies and novel food products for safe, nutritious, palatable vegetarian diets; creation of menus for healthful vegetarian diets with psychological acceptability; enzymatic procedures to degrade recalcitrant crop residues occurring in municipal waste; control-system strategies to ensure sustainabilty of a CELSS that will enable management of diverse complex systems on Earth.
Collapse
Affiliation(s)
- C Mitchell
- NASA Specialized Center of Research and Training in Bioregenerative Life Support, Purdue University, West Lafayette, IN 47907-1165, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Pellegrini R, Mariotti A, Tagliabue E, Bressan R, Bunone G, Coradini D, Della Valle G, Formelli F, Cleris L, Radice P. Modulation of markers associated with tumor aggressiveness in human breast cancer cell lines by N-(4-hydroxyphenyl) retinamide. Cell Growth Differ 1995; 6:863-9. [PMID: 7547508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The retinoid N-(hydroxyphenyl) retinamide (4-HPR) appears to be a promising tool for chemoprevention of breast carcinoma, and clinical trials to evaluate its effect are in progress. However, its action on tumor cells has remained largely undefined. We report here that 4-HPR induced apoptosis and/or differentiation in breast cancer cell lines, independent of hormone receptor status and retinoic acid receptor expression, although it was slightly more efficient in inhibiting proliferation of estrogen receptor-positive cells. 4-HPR up-modulated expression of several differentiation markers (class 1 HLA, laminin, and beta 1 integrin chain) and down-regulated expression of molecules associated with tumor progression, including the p185/HER2 oncoprotein, the epidermal growth factor receptor, and the M(r) 67,000 laminin receptor. These data suggest that 4-HPR could exert a beneficial effect by inhibiting cell proliferation and modulating breast tumor aggressiveness.
Collapse
Affiliation(s)
- R Pellegrini
- Dipartimento di Oncologia Sperimentale, Istituto Nazionale Tumori, Milano, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|