A Health Economic Framework for Expanding Access to Mental Health Treatment in an Emerging Market

Abstract

Second-generation antipsychotics are unaffordable and inconsistently available to people with schizophrenia in Rwanda. This study conducted and assessed the health economic and market access components of an initiative to improve access to these medications in Rwanda. It was conducted in the context of a partnership between a global pharmaceutical company and a governmental agency. The study employed ecosystem analysis; health economic modeling using a cost- consequence model; and the design of a feasibility study, including the selection, development, and adaptation of scales related to health economics and other topics. Insights from the implementation and production of an ecosystem analysis, health economic model, study protocol, and scales are discussed. As a result, the partnership is well-positioned to successfully execute a health economic modeling study and feasibility study, demonstrate the health economic and social impact value of second-generation antipsychotics for Rwanda, and improve access to these medications within the country. Key enablers for increasing access to schizophrenia treatment in Rwanda are presented, related to the criteria for a committed and successful partnership, and the importance of patient perceptions, task shifting, capacity building, and the decentralization of mental healthcare into community-based primary care. Key barriers to increasing access are also presented, regarding data gaps, communication, regulatory requirements, and the persistence of stigma. Implications for the implementation science and global mental health fields are considered.