Cost-effectiveness of implementing a digital psychosocial intervention for patients with psychotic spectrum disorders in low- and middle-income countries in Southeast Europe: Economic evaluation alongside a cluster randomised trial.

BACKGROUND: DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. METHODS: Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial's original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. RESULTS: The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI -0.0015, 0.0079), incremental costs of €84.17 (95% CI -8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. CONCLUSION: Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.

[Headache in displaced persons from east Slavonia]. / Glavobolje prognanika istocne Slavonije.

The authors investigate the appearance of psychogenic headaches among 150 displaced persons of both sexes, average age 43 years with specific prepared questionnaire (Incidental Report Interview with questions important for the culture of examinees), neurological and psychiatric checkups. Diagnosis of headache was established according to the criteria of the Headache Classification Committee of the International Headache Society. In the group of 150 displaced persons the authors have found 106 (70%), 31 (30%) among males and 75 (70%) among females) psychogenic headaches. Psychogenic headache appeared in 53% of the male cases and was connected with psychoticism (1.7%), conversion (8.3%) and depression (43%), and in 81% of the female cases expression of conversion (4.3%) or a follower of anxiety (10.7%) and depression (66%). Headache is together with anxiety and depression most frequently found in the age groups 31-40 and 51-60 years, among married individuals (76%), and among those with secondary school education (86%). In the group of psychogenic headaches, 13 (42%) males and 23 (30%) females had elements of muscle contraction (tension) headaches, and 9 (29%) males and 8 (10%) females, mainly from the groups 31-40 and 51-60 years with lower educational level had elements of combined vascular and tension headaches. There was a positive correlation between the employment before exile, unemployment in exile, the loss of experience in changing the place of living, leaving home and country under pressure and in peril of death and appearance and intensity of psychogenic headaches.