Developing countries cost-effectiveness studies

Shah and Jenkins (2000) in a review of mental health economic studies from around the world identified 40 cost-of-illness studies, of which five covered all disorders, one neuroses, two panic disorders and one anxiety. All were from developed countries. There were numerous cost-effectiveness studies but none involving the anxiety disorders specifically. One study in the UK examined the cost-benefit analysis of a controlled trial of nurse therapy for neurosis in primary care (Ginsberg et al, 1984). 

In recent years in some developed countries, the requisite of presenting economic evaluation (that is, pharmacoeconomic) studies of new dmgs has been introduced alongside the existing one of clinical trials. These studies have to provide proof of their efficiency (or cost-effectiveness) as a condition for the public financing of the new product. These studies improve information and market transparency and may help to make competition keener, but like the earlier requirements regarding effectiveness and safety, they constitute an additional cost factor and as such raise further barriers to entry. 

The positive relationship between income of those affected by a disease and the amount of research undertaken into pharmaceuticals for that disease has been empirically conhrmed in a variety of studies, including Lanjouw and MacLeod (2005) and Lichtenberg (2005a). The prevalence of a disease in some developing countries has often been attributed to poor food, water, and sanitation or access to treatment and may not reflect an absence of useful pharmaceuticals. In such cases it may be factors other than pharmaceutical innovation that need to be addressed. However, even if other solutions are possible, there may also be situations in which a pharmaceutical solution would be the most cost effective, if it were available. For example, it may... 

Thiazide diuretics are effective antihypertensive agents in black hypertensive patients and studies suggest that they cause a greater decrease in blood pressure in black patients than in whites. The better hypotensive response in black hypertensive patients is probably due to the fact that, in comparison with whites, more black patients have an expanded intracellular volume and low plasma renin activity. In developing countries, in which the majority of black people live, the cost of therapy is important. Thiazide diuretics are because of their low cost important baseline drugs in the treatment of hypertension. 

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