The Nonlinear Library EA - Talking through depression: The cost-effectiveness of psychotherapy in LMICs, revised and expanded by JoelMcGuire
Nov 28, 2023
09:55
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Talking through depression: The cost-effectiveness of psychotherapy in LMICs, revised and expanded, published by JoelMcGuire on November 28, 2023 on The Effective Altruism Forum.
This is the summary of the report with additional images (and some new text to explain them) The full 90+ page
report (and a link to its 80+ page
appendix) is on our website.
Summary
This report forms part of our work to conduct
cost-effectiveness analyses of interventions and charities based on their effect on subjective wellbeing, measured in terms of wellbeing-adjusted life years (
WELLBYs). This is a working report that will be updated over time, so our results may change. This report aims to achieve six goals, listed below:
1. Update our original meta-analysis of psychotherapy in low- and middle-income countries.
In our updated meta-analysis we performed a systematic search, screening and sorting through 9390 potential studies. At the end of this process, we included 74 randomised control trials (the previous analysis had 39). We find that psychotherapy improves the recipient's wellbeing by 0.7 standard deviations (SDs), which decays over 3.4 years, and leads to a benefit of 2.69 (95% CI: 1.54, 6.45) WELLBYs. This is lower than our previous estimate of 3.45 WELLBYs (
McGuire & Plant, 2021b) primarily because we added a novel adjustment factor of 0.64 (a discount of 36%) to account for publication bias.
Figure 1: Distribution of the effects for the studies in the meta-analysis, measured in standard deviations change (Hedges' g) and plotted over time of measurement. The size of the dots represents the sample size of the study. The lines connecting dots indicate follow-up measurements of specific outcomes over time within a study. The average effect is measured 0.37 years after the intervention ends. We discuss the challenges related to integrating unusually long follow-ups in Sections 4.2 and 12 in the report.
2. Update our original estimate of the household spillover effects of psychotherapy.
We collected 5 (previously 2) RCTs to inform our estimate of household spillover effects. We now estimate that the average household member of a psychotherapy recipient benefits 16% as much as the direct recipient (previously 38%). See McGuire et al. (
2022b) for our previous report-length treatment of household spillovers.
3. Update our original cost-effectiveness analysis of StrongMinds, an NGO that provides group interpersonal psychotherapy in Uganda and Zambia.
We estimate that a $1,000 donation results in 30 (95% CI: 15, 75) WELLBYs, a 52% reduction from our previous estimate of 62 (see our
changelog website page). The cost per person treated for StrongMinds has declined to $63 (previously $170). However, the estimated effect of StrongMinds has also decreased because of smaller household spillovers, StrongMinds-specific characteristics and evidence which suggest smaller-than-average effects, and our inclusion of a discount for publication bias.
The only completed RCT of StrongMinds is the long anticipated study by Baird and co-authors, which has been reported to have found a "small" effect (another RCT is underway). However, this study is not published, so we are unable to include its results and unsure of its exact details and findings. Instead, we use a placeholder value to account for this anticipated small effect as our StrongMinds-specific evidence.[1]
4. Evaluate the cost-effectiveness of Friendship Bench, an NGO that provides individual problem solving therapy in Zimbabwe.
We find a promising but more tentative initial cost-effectiveness estimate for Friendship Bench of 58 (95% CI: 27, 151) WELLBYs per $1,000. Our analysis of Friendship Bench is more tentative because our evaluation of their programme and implementation has been more shallow. It has 3 published RCTs which we use to info...
This is the summary of the report with additional images (and some new text to explain them) The full 90+ page
report (and a link to its 80+ page
appendix) is on our website.
Summary
This report forms part of our work to conduct
cost-effectiveness analyses of interventions and charities based on their effect on subjective wellbeing, measured in terms of wellbeing-adjusted life years (
WELLBYs). This is a working report that will be updated over time, so our results may change. This report aims to achieve six goals, listed below:
1. Update our original meta-analysis of psychotherapy in low- and middle-income countries.
In our updated meta-analysis we performed a systematic search, screening and sorting through 9390 potential studies. At the end of this process, we included 74 randomised control trials (the previous analysis had 39). We find that psychotherapy improves the recipient's wellbeing by 0.7 standard deviations (SDs), which decays over 3.4 years, and leads to a benefit of 2.69 (95% CI: 1.54, 6.45) WELLBYs. This is lower than our previous estimate of 3.45 WELLBYs (
McGuire & Plant, 2021b) primarily because we added a novel adjustment factor of 0.64 (a discount of 36%) to account for publication bias.
Figure 1: Distribution of the effects for the studies in the meta-analysis, measured in standard deviations change (Hedges' g) and plotted over time of measurement. The size of the dots represents the sample size of the study. The lines connecting dots indicate follow-up measurements of specific outcomes over time within a study. The average effect is measured 0.37 years after the intervention ends. We discuss the challenges related to integrating unusually long follow-ups in Sections 4.2 and 12 in the report.
2. Update our original estimate of the household spillover effects of psychotherapy.
We collected 5 (previously 2) RCTs to inform our estimate of household spillover effects. We now estimate that the average household member of a psychotherapy recipient benefits 16% as much as the direct recipient (previously 38%). See McGuire et al. (
2022b) for our previous report-length treatment of household spillovers.
3. Update our original cost-effectiveness analysis of StrongMinds, an NGO that provides group interpersonal psychotherapy in Uganda and Zambia.
We estimate that a $1,000 donation results in 30 (95% CI: 15, 75) WELLBYs, a 52% reduction from our previous estimate of 62 (see our
changelog website page). The cost per person treated for StrongMinds has declined to $63 (previously $170). However, the estimated effect of StrongMinds has also decreased because of smaller household spillovers, StrongMinds-specific characteristics and evidence which suggest smaller-than-average effects, and our inclusion of a discount for publication bias.
The only completed RCT of StrongMinds is the long anticipated study by Baird and co-authors, which has been reported to have found a "small" effect (another RCT is underway). However, this study is not published, so we are unable to include its results and unsure of its exact details and findings. Instead, we use a placeholder value to account for this anticipated small effect as our StrongMinds-specific evidence.[1]
4. Evaluate the cost-effectiveness of Friendship Bench, an NGO that provides individual problem solving therapy in Zimbabwe.
We find a promising but more tentative initial cost-effectiveness estimate for Friendship Bench of 58 (95% CI: 27, 151) WELLBYs per $1,000. Our analysis of Friendship Bench is more tentative because our evaluation of their programme and implementation has been more shallow. It has 3 published RCTs which we use to info...