Background Task-sharing treatment approaches offer a pragmatic approach to treating common mental disorders in low-income and middle-income countries (LMICs). The Friendship Bench (FB), developed in Zimbabwe with increasing adoption in other LMICs, is one example of this type of treatment model using lay health workers (LHWs) to deliver treatment. Objective To consider the level of treatment coverage required for a recent scale-up of the FB in Zimbabwe to be considered cost-effective. Methods A modelling-based deterministic threshold analysis conducted within a ‘cost-utility’ framework using a recommended cost-effectiveness threshold. Findings The FB would need to treat an additional 3413 service users (10 per active LHW per year) for its scale-up to be considered cost-effective. This assumes a level of treatment effect observed under clinical trial conditions. The associated incremental cost-effectiveness ratio was $191 per year lived with disability avoided, assuming treatment coverage levels reported during 2020. The required treatment coverage for a cost-effective outcome is within the level of treatment coverage observed during 2020 and remained so even when assuming significantly compromised levels of treatment effect. Conclusions The economic case for a scaled-up delivery of the FB appears convincing in principle and its adoption at scale in LMIC settings should be given serious consideration. Clinical implications Further evidence on the types of scale-up strategies that are likely to offer an effective and cost-effective means of sustaining required levels of treatment coverage will help focus efforts on approaches to scale-up that optimise resources invested in task-sharing programmes. Data are available upon reasonable request. Data are available on reasonable request.

中文翻译：

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大规模为常见精神障碍提供任务共享治疗的经济阈值分析：津巴布韦友谊长凳

背景 任务共享治疗方法为治疗低收入和中等收入国家 (LMIC) 的常见精神障碍提供了一种务实的方法。Friendship Bench (FB) 是在津巴布韦开发的，并在其他 LMIC 中得到越来越多的采用，它是这种使用非专业卫生工作者 (LHW) 提供治疗的治疗模式的一个例子。目的 考虑最近在津巴布韦扩大 FB 所需的治疗覆盖水平，以被认为具有成本效益。方法 在“成本-效用”框架内使用推荐的成本效益阈值进行基于建模的确定性阈值分析。结果 FB 需要额外治疗 3413 名服务用户（每个活跃的 LHW 每年 10 名），以使其扩大规模被认为具有成本效益。这假设在临床试验条件下观察到的治疗效果水平。假设 2020 年报告的治疗覆盖率水平，相关的增量成本效益比为每年 191 美元，避免残疾生活。成本效益结果所需的治疗覆盖率在 2020 年观察到的治疗覆盖率范围内，即使假设显着降低了治疗效果的水平。结论 扩大 FB 交付的经济案例在原则上似乎令人信服，应认真考虑在 LMIC 环境中大规模采用。临床意义 关于可能提供有效且具有成本效益的手段来维持所需治疗覆盖率的扩大战略类型的进一步证据将有助于集中精力于扩大投资于任务共享计划的资源的扩大方法. 可根据合理要求提供数据。可根据合理要求提供数据。