Scaling-Up a New Socio-Mental Health Service Model in Iran to Reduce Burden of Neuropsychiatric Disorders: An Economic Evaluation Study

Scaling-Up a New Socio-Mental Health Service Model in Iran to Reduce Burden of Neuropsychiatric Disorders: An Economic Evaluation Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Scaling-Up a New Socio-Mental Health Service Model in Iran to Reduce Burden of Neuropsychiatric Disorders: An Economic Evaluation Study Seyede Sedighe Hosseinijebeli, Aziz Rezapour, Ahmad Hajebi, Maziar Moradi Lakeh, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-52097/v2 This work is licensed under a CC BY 4.0 License Status: Under Review Version 2 posted 8 You are reading this latest preprint version Show more versions Abstract Background: The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs. Methods: This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of medicines, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case. Results: The health impacts are calculated in terms of healthy life years gained, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in basic scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5,550 US dollars for Iran. Conclusions: Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. Health Policy Mental Health Economic evaluation Universal Health Coverage Introduction Mental health is regarded as an integral part of an individual’s capacity to lead a fulfilling life. Disturbances of a person’s mental well-being can thus adversely compromise this capacity as well as choices made in this respect, resulting not only in diminished functioning at individual level but also broader welfare losses for households and society [1]. Although effective interventions have been thus far introduced and affordable methods for their delivery have been shown to work, scaling-up the quality of mental health services has not occurred in most countries. Accordingly, mental health care should be included as an essential component of universal health coverage (UHC) and even fully integrated into global response to other health priorities whereas access to quality of care and financial risk protection is ensured [2]. To note, depression and anxiety are also responsible for more than 10% of the global burden of disease (GBD) and cost $1 trillion every year in terms of lost productivity. This is accordingly a significant cost with regard to the years of (healthy) life lost (YLL) and the existing situation makes life much harder for the most vulnerable people in the world. Three quarters of the mental health disease burden is observed in low-to-middle-income countries (LMICs), and governments and households - those least able to afford it - bear the burden of mental health care costs [3]. Current coverage of essential mental health care services in LMICs is very limited. Resources made available by governments for provision of community-based and person-centered mental health care services are often very modest. The resources that are made available are also typically directed towards more specialized and institutional services, which are not easily accessible. Without appropriate access to decent services and adequate protection, individuals with mental disorders and their families are correspondingly facing a difficult choice, namely, paying out of pocket for treatments of variable and sometimes poor quality or going without treatments altogether [4]. The economic consequences of low investments in mental health are staggering, with an estimated loss of US$16 trillion to the global economy due to mental disorders (for the period: 2010-30), driven in part by the early age of onset and loss of productivity across the life course. In 2011, the Grand Challenges in Global Mental Health initiative led by the United States (US) National Institute of Mental Health (NIMH) prioritized implementation research questions to reduce treatment gaps for mental disorders. The first priority identified was the integration of core packages of mental health care services into routine primary health care (PHC) ones [2]. Addressing the large and growing burden of mental, neurological, and substance use (MNS) disorders at the population level via scaled-up implementation of evidence-based treatment and prevention has been repeatedly essential over the past decade, and it can be expected to place new resource demands on the health systems of LMICs [4]. In Iran, about three percent of health care expenditure is allocated to mental health [5]. There are 20 mental health workers per 100,000 Iranians as for 2017 and there was a significant increase compared to 11 per 100,000 population in 2011. The breakdown according to profession is as follows: psychiatrists (2.2 per 100,000), child psychiatrists ( 0.15 per 100,000) , other medical doctors, not specialized in psychiatry (0.63 per 100,000), nurses (9.45 per 100,000), psychologists (5.17 per 100,000), social workers (1.51 per 100,000), occupational therapists (1.01 per 100,000) and speech therapist ( 0.63 per 100,000) . Nearly 5,192 in 100,000 of the general population visit outpatient facilities, mostly community-based facilities, while there are about 28.5 beds per 100,000 populations, in various settings including community-based facilities and hospitals [6]. Based on the transition of mental health care in Iran within about two decades, from introducing basic mental health care in PHC to the experience of community-based mental health centers (CMHC) for urban areas [7], a new socio-mental health service model, with two basic and advanced service strata, has been so far proposed. The first mental health program was piloted from 1992 to 1994 and after more than two decades, it now covers 18 million (82.8%) rural residents and 10 million (21.7%) citizens in urban areas. The program mainly addressed severe mental health disorders, epilepsy, and mental retardation. While it has been proven successful for villages, this program is not sufficient for those residing in urban areas. In response to the need of urban dwellers, the structure of CMHC for urban areas was designed to target those with neurotic disorders including depression and anxiety as well as severe mental disorders such as schizophrenia, bipolar disorder, and suicide attempts [8]. The new socio-mental health service model is thus comprised of two levels of health services, i.e., basic and advanced mental health services. The basic level services include public education on the basics of socio-mental health skills and screening. At this level, cases with target mental conditions are recognized by community health workers and then referred to mental health specialists for further evaluations and interventions. Using an inter-sectorial approach, patients in need of social services should be referred to a relevant service provided by other organizations in order to strengthen their social support [8]. The advanced socio-mental health services take account of facilities for mental and social emergencies and provide treatments for referrals from level one. Such services should be delivered by a collaborative care team comprised of psychologists, clinical psychiatrists, etc. at the integrated mental health settings such as PHC health centers, CMHCs, and hospitals [8]. Accordingly, scaling-up mental health services in a successful manner involves putting a range of human, physical, and other resource inputs together in order to deliver interventions and services capable of improving mental health status and related outcomes. In view of that, an essential element of evidence-based mental health service planning and scaling-up is related to an assessment of what resources are required for delivering of services to populations in need and meeting program goals [9]. Therefore, this study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs to make an investment case to be considered by policy-makers for further evidence-based policy-making. The perspective chosen for this study is healthcare system, specifically ministry of health which responsible for providing mental health services through primary healthcare settings and hospitals. While healthcare perspective provides a straightforward analysis of costs and health gains for policy makers, the societal view can capture both costs and impacts in a comprehensive scale which will be more convincing once the evidence is used for budget negotiation at national level. Although, considering social costs is often in favor of cost-effectiveness of mental health interventions [10], the societal perspective has not been taken into account as the OHT methodology does not provide technical capacity for such estimation. Methodology Study Design and Tools This study was a cost-consequence analysis to examine the expected health gains as well as costs of scaling-up certain interventions to reduce the burden of mental disorders in different groups of patients suffering from anxiety, depression, bipolar disorder, and epilepsy in Iran. The scaling-up scenario was thus tested against the no scaling-up scenario with the existing level of care offered in the system. The data required for the study were collected in the first quarter of the year 2020 and the time horizon was a 10-year period from 2020 to 2030. Although the amount of services provided in the private sector is considerable and includes 75% of outpatient services [11], in this study we assumed ministry of health as the single provider in order to restrict the scope of research and gather high quality data to make precise estimations. It was therefore assumed that all the services were being provided by the government within the facilities of the Ministry of Health and Medical Education (MOHME) and the analysis was fulfilled based on its perspective. One Health Tool Module on MNS Disorders The OneHealth Tool (OHT), a software tool developed by the international costing experts from the World Health Organization (WHO) and other United Nations (UN) agencies, was employed to start this study. The mental health module of the OHT was accordingly developed in order to ensure that the national mental health development plans have been carried out within a framework of assessment of overall health system capacity and to take financial sustainability and outcomes-based planning into account [12]. Research Planning Consulting with three main national planners at the Department of Mental Health in the MOHME who are in charge of this program, priority MNS disorders including depression, anxiety, bipolar disorder, and epilepsy were selected. The main criteria to select these interventions include 1) Provision of care within the centers affiliated by ministry of health: for instance, the drug abuse treatment was excluded as the services are mainly provided in other sectors. 2) Burden of diseases: as reflected in the introduction, these disorders are among most prevalent ones in national and global levels and 3) The inclusion of the interventions in OHT impact module: Since not all of the interventions are included in this module to estimate health impacts , we checked the available interventions and excluded ones which are not provided in impact modules and then we finalized eight interventions. It is noteworthy that these interventions are recommended in WHO Mental Health Gap Action Program (mhGAP) guideline [13] as standard and effective interventions. So, their effectiveness is proved through RCTs and Systematic reviews which are formulated in the OHT to estimate the health impacts. Although national estimation of effectiveness would better describe the situation , it hasn’t been in the scope of this study to estimate these measures and no national studies were available too. Therefore, we relied on the global and regional evidence of effectiveness in the OHT. Moreover, appropriate mental health care packages and scenarios, current and target coverage levels for specific intervention strategies, and scaling-up period were identified through consultations with the expert group of national planners and program managers. For clinical-level consideration of resource use profiles for different disorders and interventions, unit costs and prices for health care services and commodities (such as those for staff salaries, outpatient visits, and psychotropic medications), one of the pilot sites (namely, the city of Oskoo in East Azerbaijan Province) was selected. This new service model was initially implemented in three cities [14]. Although a formal evaluation was not performed to compare the process in these three pilot sites, based on the regular observations, national managers of the program believe that Oskoo is the best practice to the program, benefiting from excellent documentation and assessments. To collect these inputs, the research team, working with local team members and other national staff, identified and utilized local data sources and visited the site in a three-day tour. The data checklist adapted from the study by Chisholm [12] was also modified and used in order to facilitate and document the process of data contextualization. Data Contextualization Health Impacts The selected metric for summarizing health effects at the population level is (healthy) life years (LYs) gained (equivalent to disability-adjusted life years (DALYs) averted), where one DALY could be thought of as one YLL. (Healthy) LYs is also computed with reference to country-specific life tables that have been already built into the model, and reflect the combined time spent by the population in a particular state of health with a known degree (or free) of disability. Default disability levels in OHT were drawn from the GBD 2010 study [15]. Implementing or scaling-up an effective intervention in the population was thus modeled to reduce the time spent in a disabling state, either by reducing prevalence (e.g., by decreasing the number of new cases or increasing the remission rate), or by improving the level of functioning in people with the condition in question [12]. Epidemiology Iran has a history in mental health surveys and it is therefore possible to make use of high-quality epidemiological data from the national surveys [16, 17, 18]. However, to meet age-stratified data sheets of the OHT on the prevalence and incidence rates for all disorders, the 2017 GBD estimates available in GBD result tool ( http://ghdx.healthdata.org/gbd-results-tool ) were used. The prevalence and incidence rates were extracted for the four disorders including depression, anxiety, bipolar and epilepsy and the data were sorted for male and female in 17 age groups. Then, to meet the OHT requirements for data entry, these rates were modified to cases per 1,000 population. Estimating Resources, Costs, and Coverage Levels The key categories of health service costs in the OHT included drug and supply costs (e.g., daily dose of a generically produced first-line anti-psychotic or anti-epileptic medication), costs of response to ambulatory contacts by mental health or general health workers (such as psychologists, counselors, and community health workers), and costs of hospital-based outpatient/inpatient care services. In addition, program-level resource needs were identified, including overall program management and administration as well as training [12]. Intervention Costing Resources used in terms of drug and supply, staff salaries, and outpatient visits were documented through field visits to the pilot site and the associated costs were subsequently estimated based on accounting documents available in the program management office in order to estimate the average cost of each intervention per case. As described in the introduction of the new care model, basic package of care (e.g. basic psychosocial treatment plus medication therapy of moderate cases of anxiety/depression) were being provided in health care facilities and severe cases of those disorders in addition to all bipolar cases could be referred to the CMHCs for intensive care and social support. It is noteworthy that the WHO mhGAP guideline was practiced with slight changes in real time spent and availability of recommended drugs in the whole system of integrated mental health care in PHC. All three levels of care (health care facility, CMHC, and general hospital (psychiatric ward)) were accordingly visited and all staff including community health workers, socio-mental health experts, general practitioners, psychologists, psychiatrists, and social workers were interviewed in order to identify activities and estimate time spent for each patient and intervention. The drug and supply list used for each intervention was also documented and the price list was acquired from the health information system (HIS) of the hospital with a particular focus on most-prescribed medications available in the primary care setting. It should be noted that drug and supply prices have the same tariffs across the country in public hospitals and the PHC network. Program Costing Program specific costs concern the cost incurred at the national and provincial level to manage and supervise the program. Information on the program-specific staff required for scaling-up were obtained from background strategic documents of the program available at the Department of Mental Health including a unit cost study of new socio-mental program, so-called SERAJ, in the year 2018 [19]. In order to estimate the cost of supervision and auditory visits as well as necessary trainings, the district managers were interviewed in the field visit and costing parameters including transportation, trainings and allowances to take part in missions were identified. Total Cost The total costs of scaling-up an intervention in a given year for a country was thus derived by multiplying resource use needs by their respective unit costs to give an average cost per case. It was then multiplied by the total number of cases, expected to receive a particular intervention (given by the prevalence of the disorder multiplied by the rate of treatment coverage of specific intervention strategies in the population), that is, total cost=population×prevalence rate×coverage×treatment cost per case [12]. To estimate the costs, the expected inflation rate for the period: 2020 -2030 was applied using extrapolation based on the actual inflation rates for 2010-19. Since all the costs were calculated in Iranian Rial (IRR), to convert the costs in US$, the exchange rate for the study period was estimated through extrapolation based on the UN exchange rates for the past 10 years. Coverage In order to estimate present and future coverage levels, we have conducted three rounds of panel discussions with three national policy makers and three provincial managers who have been in charge of this program at national and district levels. The first panel was conducted at the beginning of the research, the second one was just at the early beginning of data collection and the last one during the filed visit in the pilot site. All the estimations of coverage were made based on the population covered in each area and expected coverage in the future based on the available budget. In order to make sure about coverage levels, we re-checked measures before and after field visits and examined different scenarios. The estimates of the baseline coverage were based on the coverage of health care facilities per population. Given the expected challenges of scaling-up the new model at the national level, a modest coverage target of 30-40% by 2030 was set for the intensive packages of care and 60-70% target coverage was considered for the basic package, which have already had 40% baseline coverage. Assumptions In this study, the volume of services provided in the private sector was not estimated. It was assumed that all the services had been provided by the government within the facilities of MOHME. Besides the base case scenario which is provided below, we examined seven others scenarios in order to provide a sensivity analysis. Currencies reported At first, all the costing parameters were estimated in IRR (Iranian Rial) as local currency values were used in the context of ongoing policy dialogue, then all the cost values were converted into the US dollars for ease of interpretation and comparison. The exchange rate was captured from the UN exchange rates in June 2020 which equals to 194,881 IRR. In addition, the final result of cost per each health life years were also reported in Intl dollars (PPP adjusted) to provide a more realistic view while the results are compared to that of different countries. In order to convert values to Intl dollars we used the cost conversion tool developed by Campbell Collaboration ( https://eppi.ioe.ac.uk/costconversion/ ). The underlying methods of this tool is provided in the paper published in the journal of Evidence and Policy [20]. Results Table 1: Intervention coverages (%) - Front Loaded pattern Scale up period Anxiety disorders Basic psychosocial treatment and anti-depressant medication for anxiety disorders Intensive psychosocial treatment and medication therapy for anxiety disorders Depression Basic psychosocial treatment and anti-depressant medication of first episode cases Intensive psychosocial treatment and anti-depressant medication of first episode cases Intensive psychosocial treatment and anti-depressant medication of moderate-severe cases on a maintenance basis Bipolar disorder Intensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication Epilepsy Basic psychosocial support, advice, and follow-up, plus anti-epileptic medication After consulting the national managers of the program, the baseline coverage levels (2020) as well as the target ones (2030), were defined for each of the interventions. Among different scaling-up patterns available in the tool including linear, S-shaped, front-loaded, and exponential, the front-loaded interpolation pattern, recommended for middle-income countries was chosen. Front loaded interpolation is basically applying a calculation pattern to reflect an assumption that scaleup happens relatively quickly (in the first years of the projection) and then coverage increases slow down. We tend to see this kind of pattern when the building blocks are in place to roll out a new service or expand an existing one. The coverage levels for all the interventions in each year are presented in Table 1. Table 2: Total co sts 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Total Intervention costs 8,448,265 13,488,255 18,621,150 23,847,368 29,150,836 34,514,740 39,924,870 45,361,257 50,808,697 56,257,325 61,698,157 382,120,919 Program costs 141,575 301,207 424,001 560,520 683,314 819,833 942,627 1,051,697 1,162,739 1,269,838 1,378,908 8,736,258 Labor costs 31,012,194 42,009,848 53,232,422 64,666,007 76,263,942 87,984,733 99,796,025 111,651,997 123,519,471 135,378,198 147,209,639 972,724,477 Total costs 39,602,034 55,799,310 72,277,573 89,073,895 106,098,092 123,319,306 140,663,522 158,064,951 175,490,907 192,905,361 210,286,703 1,363,581,654 Per Capita 16.42 The total cost including both intervention and program costs for all interventions selected from the module of mental and neurological disorders are illustrated in Table 2. To note, all the cost values were converted into the US dollars for ease of interpretation and comparison, but local currency values were used in the context of ongoing policy dialogue. Table 3: Healthy Years Gained Impact scale up 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Total Depression 0 35,873 59,717 78,750 95,490 110,979 125,688 139,854 153,611 167,043 180,231 1147236 Anxiety 0 8,235 13,966 19,595 25,477 31,699 38,272 45,177 52,380 59,847 67,544 362192 Bipolar 0 4,461 6,371 7,658 8,660 9,498 10,229 10,884 11,480 12,027 12,534 93802 Epilepsy 0 1,691 3,423 5,199 7,018 8,879 10,774 12,698 14,645 16,610 18,588 99525 Total 0 50,260 83,477 111,202 136,645 161,055 184,963 208,613 232,116 255,527 278,897 1,702,755 As shown in Table 3, the health impacts are calculated in terms of (healthy) LYs gained for 2020-30, after adjusting the prevalence and incidence rates for each disorder in the NCD impact module. Depression has the biggest share in the health impact, as it is the most prevalent mental disorder in Iran. In total, 1,702,755 (healthy) LYs were expected to be gained via scaling-up the program at national levels. Considering the total 1,363,581,654 US dollars cost, each (healthy) LY gained will cost around 801 US dollars. Table 4: Sensivity Analysis Scenarios Base case(Front loaded) Scale Up Pattern Epidemiologic data CIs Expected Coverage Levels Exponential Linear Lower Upper Coverage 1 Coverage 2 Coverage 3 Intervention costs 382,120,919 390,611,079 387,772,875 305,783,940 476,662,810 392,627,220 448,247,779 372,911,819 Program costs 8,736,258 8,736,258 8,736,258 8,736,258 8,736,258 8,736,258 8,736,258 8,736,258 Labor costs 972,724,477 994,357,774 987,228,401 778,324,069 1,213,512,516 1,014,058,490 1,065,250,321 934,160,222 Total costs 1,363,581,654 1,393,705,112 1,383,737,535 1,092,844,267 1,698,911,584 1,415,421,968 1,522,234,357 1,315,808,299 Impact scale up Depression 1,147,236 753,131 957,688 934,294 1,403,864 1,105,159 1,439,832 1,105,371 Anxiety 362,192 282,307 324,450 316,006 418,867 310,894 435,672 311,346 Bipolar 93,802 38,658 67,133 65,494 130,647 93,802 128,165 93,802 Epilepsy 99,525 88,300 94,216 61,126 150,542 65,234 99,525 65,716 Total Impact 1,702,755 1,162,396 1,443,487 1,376,920 2,103,920 1,575,089 2,103,194 1,576,235 Cost per a Healthy LY (US$) 801 1199 959 794 807 899 724 835 Cost per a Healthy LY (Intl$/ PPP Adjusted) 7714 11548 9236 7647 7772 8658 6973 8042 In order to provide a sensivity analysis, we have examined three sets of scenarios changing the scale up patterns, investigating the lower and upper bound of Confidence Intervals (CIs) for prevalence and incidence rates and finally changing the coverage levels. As shown in the table 4, the cost per a healthy LY changes from 1199 US$ in exponential pattern to 959 in linear one. Based on the health system development level in Iran, the front-loaded pattern, recommended for middle income countries, is selected and other scenarios are tested against it. Then, in the next set of scenarios, the epidemiological data, obtained from GBD estimates, were changed using the CIs of reported prevalence and incidence rates resulting in a range of 794 to 807 US dollars per each healthy LY gained. Finally, we have examined different coverage levels as the main driver for costs and impacts. In the scenario “Coverage 1”, we have changed the existing coverage of basic interventions from 40% to 50% while in the “Coverage 2” scenario the target level for intensive care was adjusted for 40% instead of 30% in base case scenario. Moreover, in the scenario “Coverage 3” the target level for the basic package were reduced considering 60% level of coverage. Based on the WHO criteria [21], all of these values ranged from 724 to 1199 US$ obtained through eight different scenarios were considered as cost-effective. Discussion In the face of large and increasing burden of mental diseases and treatment gaps existing in Iran, a new socio-mental health service model was introduced to the mental health system of this country. This program, available in PHC settings, could significantly contribute to achieving the goals of the UHC for the MNS disorders in terms of financial protection and service provision. This study was further concerned with informing national policy-makers about resource needs and costs of scaling-up such mental health services in national level. The OHT methodology used by Chisholm [12] was followed in this study. In comparison with their estimation for five LMICs, the results of this study indicated that the resource needs for scaling-up mental health services did not need to be substantial. Although differences in health system development, service packages, and costing requirements make it much difficult to compare results between various countries in such studies, the cost estimated here for Iran in the base case scenario was 801 US dollars in terms of cost per (healthy) LY gained. This value was far less than what was estimated for South Africa, around 18,000 US dollars, whose per capita income was comparable to that of Iran as a middle-income country. This estimation was somehow analogous to that of India with 761 US dollars per (healthy) LY gained from scaling-up their mental health program [12]. In another cost-effectiveness analysis of an essential mental health intervention package in Nigeria [22], the cost per each DALY averted for a package of care including depression, schizophrenia, epilepsy, and hazardous alcohol use was estimated 320 US dollars. In addition, the study of cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya [23] estimated the cost of a DALY averted around Int$ 727 from the health system perspectives. In a more recent study in Ethiopia, a cost-effectiveness analysis about scaling-up essential neuropsychiatric services for treatments of depression, schizophrenia, bipolar disorder and epilepsy were performed [24]. Based on the results of this study, treatment of epilepsy with a first-generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457–1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168–3739 per DALY adverted). Generally, the cost of bipolar and schizophrenia treatments are two or three times higher than that of depression and epilepsy which often don’t need hospitalization and specialist services. In the present study, through examining different scenarios, it was shown that achieving more coverage level in new socio-mental health in terms of increased level of intensive care package (increasing the expected level from 30% to 40%) could significantly reduce the cost per each (healthy) LY gained from 801 US$ in base case to 724 US$ in respective scenario. It means that by expanding this new service model aimed at urban population, more (healthy) LY will be gained and the cost per each (healthy) LY will decrease. Comparisons made between different scenarios show that introduction of this new service model in urban areas is cost-effective while the basic package of care is well-developed in rural areas. It is noteworthy that all the health gains based on the base case would cost 16.4 US dollar per capita in the next ten years from the health system perspective which is not substantial compared to the health expenditure per capita equal to 484 US dollars as for 2018 ( https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=IR ) and can in turn greatly increase the access to the mental health care by citizens and is considered an important step forward in order to achieve universal health coverage in mental health. In addition, as reported in an economic analysis study [25] based on the unit costs of this program in the pilot level, considering 116 570 people in order to be screened and treated within this model , the per capita cost was estimated 5.56 US dollar which seems comparable to our estimation as we did a prospective estimation in the national level for the next ten years considering inflation rate. Furthermore, based on 2014 atlas of mental health [26], the per capita mental health cost in Iran is reported 1.73 US dollars while in the same year the health expenditure per capita equals to 432 US dollars. This figure demonstrates how neglected is the mental health sector and how this new service model could contribute to greater access and improved mental health with relatively small amount of funds. Furthermore, based on the WHO criteria for cost-effectiveness threshold [21], cost per (healthy) LY gained (i.e., DALY averted) was considered very cost-effective if it was less than a gross domestic product (GDP) per capita in a specified country. The estimation of 801 US dollars (7714 Intl dollars) per (healthy) LY gained through the scaling-up period of the new socio mental health care could be regarded cost-effective as well given the GDP per capita of 5550 US dollars (12,937 Intl dollars) for Iran in 2018 (2019) ( https://data.worldbank.org/indicator/NY.GDP.PCAP.PP.CD?locations=IR ). Therefore, the health returns on such an investment are substantial. Such information on the costs and health impacts of scaling-up could further provide important evidence that could be used in dialogues with health planners and policy-makers at the national level, particularly in the context of increased policy attention to the rising burden of mental and neurological disorders. Conclusion Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar [5,26], which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar for scaling up this comprehensive mental health service model besides previous studies (19, 25) reporting 5.56 US dollar per each person, can convince high-level policy-makers to increase the share of mental health budget accordingly. Using the OHT strategic planning reflecting on the expected health gains and the associated costs, could help policy-makers with evidence-informed policy- making to prioritize cost-effective interventions and to improve allocative efficiency. The present study provided a timely analysis as the Department of Mental Health in Iran sought to implement an ambitious plan of mental health scaling-up across the country, collaborating with the MOHME and the Ministry of Interior. Therefore, this work could make a useful contribution to state-level deliberations on the implementation of this plan at national level. Expanding such works beyond the mental health to all non-communicable diseases (NCDs) and making comparisons within and between specific packages of cares can be thus great evidence while the programs are developing at different departments aimed to be scaled-up at national and sub-national levels. Limitations Working with the OHT through different modules can be a challenging job with hundreds of parameters to be revised and updated. A broad concern is also related to the available national evidence on a number of domains. These include epidemiological data on the burden of the MNS disorders, extent of current coverage and expenditure, as well as evidence base for locally adapted cost-effective interventions. While regional and global default estimates are available, the tool developers strongly encourage updating parameters with national estimates. To update the prevalence and incidence rates, the GBD estimates were accordingly used as the last national mental health survey of Iran did not include estimates on the incidence rates while the prevalence rates had been also limited to major depression and anxiety. In case of cost- effectiveness of interventions and transition rates (e.g. remission and mortality rates), the default OHT rates were employed, since there were no national estimates or even studies investigating such parameters. Abbreviations Universal Health Coverage (UHC) Years of (healthy) Life Lost (YLL) Global Burden of Disease (GBD) Low- and Middle-Income Countries (LMICs) United States (US) National Institute of Mental Health (NIMH) Primary Health Care (PHC) Mental, Neurological, and Substance use (MNS) Community-Based Mental Health Centers (CMHC) Ministry of Health and Medical Education (MOHME) One Health Tool (OHT) World Health Organization (WHO) United Nations (UN) Disability-Adjusted Life Years: DALYs Mental Health Gap Action Program (mhGAP) Health Information System (HIS) Confidence Intervals (CIs) Non-Communicable Diseases (NCDs) Declarations Ethics approval and consent to participate Not Applicable Consent for publication Not Applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study is supported financially by Iran University of Medical Sciences and is also approved by the ethical committee of the university under the research ethic code: IR.IUMS.REC.1397.050 Authors' contributions SHJ have proposed the topic and the study was designed by SHJ and AR. The study protocol was finalized in collaboration with MML and AH. The epidemiological data was gathered by SHJ, MML and AH while SHJ, AR and BD accomplished the costing part. The data were analyzed by SHJ and then critically interpreted by AR, MML and AH. SHJ drafted the paper and all authors reviewed it accordingly and have provided their input. Acknowledgements This study is part of the PhD thesis by Ms. Seyede Sedighe Hosseini Jebeli supported by Iran University of Medical Sciences with grant number IUMS/SHMIS/1397-2-37-12423. We would also like to express our sincere gratitude to Mr Vahab Asl Rahimi, Director of Mental Health of east Azarbaijan Province Health center, and Mrs Azam Hemmati, Expert of Mental Health and all colleagues in Tabriz University of Medical Sciences who supported us both technically and administratively in order to collect data to accomplish this project. References World Health Organization. Investing in mental health: evidence for action. Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, Chisholm D, Collins PY, Cooper JL, Eaton J, Herrman H. The Lancet Commission on global mental health and sustainable development. The Lancet. 2018 Oct 27;392(10157):1553-98. Caddick H, Horne B, Mackenzie J, Tilley H. Investing in mental health in low-income countries. London: Overseas Development Institute. 2016 Dec. Chisholm D, Docrat S, Abdulmalik J, Alem A, Gureje O, Gurung D, Hanlon C, Jordans MJ, Kangere S, Kigozi F, Mugisha J. Mental health financing challenges, opportunities and strategies in low-and middle-income countries: findings from the Emerald project. BJPsych open. 2019 Sep;5(5). World Health Organization. WHO-AIMS report on mental health system in the Islamic Republic of Iran. Tehrran, Iran: World Health Organization—Assessment Instrument for Mental Health Systems. 2006. World Health Organization. Mental health atlas 2017: resources for mental health in the Eastern Mediterranean Region. Sharifi V, Hajebi A, Damari B, Mohammadjafari A. Specialized Outpatient Services in the SERAJ Program: Community Mental Health Centers (CMHCs). Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):32-8. Damari B, Alikhani S, Riazi-Isfahani S, Hajebi A. Transition of mental health to a more responsible service in Iran. Iranian journal of psychiatry. 2017 Jan;12(1):36. Chisholm D, Burman-Roy S, Fekadu A, Kathree T, Kizza D, Luitel NP, Petersen I, Shidhaye R, De Silva M, Lund C. Estimating the cost of implementing district mental healthcare plans in five low-and middle-income countries: the PRIME study. The British Journal of Psychiatry. 2016 Jan;208(s56): s71-8. Duevel JA, Hasemann L, Peña-Longobardo LM, Rodríguez-Sánchez B, Aranda-Reneo I, Oliva-Moreno J, López-Bastida J, Greiner W. Considering the societal perspective in economic evaluations: a systematic review in the case of depression. Health economics review. 2020 Dec;10(1):1-9. Damari B, Mafimoradi S. Intersectoral expectations for promoting mental health: A qualitative case study of Islamic Republic of Iran. International journal of preventive medicine. 2019;10. Chisholm D, Heslin M, Docrat S, Nanda S, Shidhaye R, Upadhaya N, Jordans M, Abdulmalik J, Olayiwola S, Gureje O, Kizza D. Scaling-up services for psychosis, depression and epilepsy in sub-Saharan Africa and South Asia: development and application of a mental health systems planning tool (OneHealth). Epidemiology and Psychiatric Sciences. 2017 Jun;26(3):234-44. World Health Organization. mhGAP: Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders. Geneva: World Health Organization; 2008. Damari B, Asgardoon MH. Evaluation of the Community Action Package in Iran's Mental and Social Health Services Model (the SERAJ Program). Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):12-22. Salomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, Mokdad A, Begum N, Shah R, Karyana M, Kosen S, Farje MR. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 15;380(9859):2129-43. Noorbala AA, Faghihzadeh S, Kamali K, Yazdi SA, Hajebi A, Mousavi MT, Akhondzadeh S, Faghihzadeh E, Nouri B. Mental health survey of the Iranian adult population in 2015. Archives of Iranian medicine. 2017 Mar 1;20(3):0-. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, Rahimi-Movaghar A. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Archives of Iranian medicine. 2015 Feb 1;18(2):0-. Rahimi-Movaghar A, Sharifi V, Motevalian A, Amin-Esmaeili M, Hadjebi A, Rad Goodarzi R. Iranian National Mental Health Survey: prevalence, severity and costs of mental disorders and service utilization (IranMHS). Tehran: Mehrsa. 2014. Damari B, Hajebi A, Abolhallaje M, Najafi B. How Much Should We Pay to Deliver Comprehensive Mental Health Services? Experiences from Iran. Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):39-45. Shemilt I, Thomas J, Morciano M. A web-based tool for adjusting costs to a specific target currency and price year. Evidence & Policy: A Journal of Research, Debate and Practice. 2010 Jan 1;6(1):51-9. Bertram MY, Lauer JA, De Joncheere K, Edejer T, Hutubessy R, Kieny MP, Hill SR. Cost–effectiveness thresholds: pros and cons. Bulletin of the World Health Organization. 2016 Dec 1;94(12):925. Gureje O, Chisholm D, Kola L, Lasebikan V, Saxena S. Cost-effectiveness of an essential mental health intervention package in Nigeria. World Psychiatry. 2007 Feb;6(1):42. de Menil V, Knapp M, McDaid D, Raja S, Kingori J, Waruguru M, Kippen Wood S, Mannarath S, Lund C. Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya. Psychological medicine. 2015 May 21;45(12):2747-56. Strand KB, Chisholm D, Fekadu A, Johansson KA. Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis. Health policy and planning. 2016 May 1;31(4):504-13. Damari B, Vosoogh-Moghaddam A, Hajebi A, Amirhoseiny S. Iran's Comprehensive Mental and Social Health Services (the SERAJ Program): Economic Considerations and Financial Policy Recommendations. Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):59-64. World Health Organization. Mental health Atlas country profile 2014. Cite Share Download PDF Status: Under Review Version 2 posted Editorial decision: Minor revision 19 Mar, 2021 Review # 1 received at journal 16 Mar, 2021 Reviewer # 2 agreed at journal 01 Mar, 2021 Reviewer # 1 agreed at journal 15 Feb, 2021 Reviewers invited by journal 14 Feb, 2021 Editor assigned by journal 01 Jan, 2021 Submission checks completed at journal 01 Jan, 2021 Editor invited by journal 01 Jan, 2021 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-52097","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":7876327,"identity":"1af21715-147c-46cd-8605-226c1aef7eb0","order_by":0,"name":"Seyede Sedighe Hosseinijebeli","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Seyede","middleName":"Sedighe","lastName":"Hosseinijebeli","suffix":""},{"id":7876328,"identity":"2c3f9ef3-3f1d-488d-affe-b740156132e0","order_by":1,"name":"Aziz Rezapour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYHAD5gMHYMwDuFWhALYEkrXwGBCnzry9/eHngorD+QzsZz4e5s2pY+BvP8B4uAKPFpkzB5KlZ5w5bNnAk7vhMO+2wwwSZxIYDp7Bo0VCIuGANG/bYaCjwFqAvrjBwHCwAZ8W+YfNv8Fa+N88AGqpY5AnqEWCmQ1ii0QOA1ALM4MBQS08aWzWM86kG7BJPDM4OHfbYR7DM4kN+LWwH398u6DC2oCfP/nxh7fb6uTkjh8+/BGfFhBgBhFsUA4PAwMjIQ1QLaNgFIyCUTAKcAIAErlKvcPfa/YAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-4032-0802","institution":"Iran University of Medical Sciences : Tehran, Tehran, Iran","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Aziz","middleName":"","lastName":"Rezapour","suffix":""},{"id":7876329,"identity":"34e73a4d-e0df-46c3-a265-2a81316cf436","order_by":2,"name":"Ahmad Hajebi","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Hajebi","suffix":""},{"id":7876330,"identity":"c0019e3b-7126-42cc-9dd5-b6c0ec3552f4","order_by":3,"name":"Maziar Moradi Lakeh","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maziar","middleName":"Moradi","lastName":"Lakeh","suffix":""},{"id":7876331,"identity":"e028c755-bee7-4ecb-9c96-f347e2b96b00","order_by":4,"name":"Behzad Damari","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Behzad","middleName":"","lastName":"Damari","suffix":""}],"badges":[],"createdAt":"2020-08-01 10:19:42","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-52097/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-52097/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13648669,"identity":"312059eb-c861-4b18-bfc9-fdda2988aef1","added_by":"auto","created_at":"2021-09-17 09:33:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":653902,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-52097/v2/9aa50d96-cf9f-43cf-9d63-f6fd05d3f584.pdf"}],"financialInterests":"","formattedTitle":"Scaling-Up a New Socio-Mental Health Service Model in Iran to Reduce Burden of Neuropsychiatric Disorders: An Economic Evaluation Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health is regarded as an integral part of an individual\u0026rsquo;s capacity to lead a fulfilling life. Disturbances of a person\u0026rsquo;s mental well-being can thus adversely compromise this capacity as well as choices made in this respect, resulting not only in diminished functioning at individual level but also broader welfare losses for households and society [1].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough effective interventions have been thus far introduced and affordable methods for their delivery have been shown to work, scaling-up the quality of mental health services has not occurred in most countries. Accordingly, mental health care should be included as an essential component of universal health coverage (UHC) and even fully integrated into global response to other health priorities whereas access to quality of care and financial risk protection is ensured [2].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo note, depression and anxiety are also responsible for more than 10% of the global burden of disease (GBD) and cost $1 trillion every year in terms of lost productivity. This is accordingly a significant cost with regard to the years of (healthy) life lost (YLL) and the existing situation makes life much harder for the most vulnerable people in the world. Three quarters of the mental health disease burden is observed in low-to-middle-income countries (LMICs), and governments and households - those least able to afford it - bear the burden of mental health care costs [3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrent coverage of essential mental health care services in LMICs is very limited. Resources made available by governments for provision of community-based and person-centered mental health care services are often very modest. The resources that are made available are also typically directed towards more specialized and institutional services, which are not easily accessible. Without appropriate access to decent services and adequate protection, individuals with mental disorders and their families are correspondingly facing a difficult choice, namely, paying out of pocket for treatments of variable and sometimes poor quality or going without treatments altogether [4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe economic consequences of low investments in mental health are staggering, with an estimated loss of US$16 trillion to the global economy due to mental disorders (for the period: 2010-30), driven in part by the early age of onset and loss of productivity across the life course. In 2011, the Grand Challenges in Global Mental Health initiative led by the United States (US) National Institute of Mental Health (NIMH) prioritized implementation research questions to reduce treatment gaps for mental disorders. The first priority identified was the integration of core packages of mental health care services into routine primary health care\u0026nbsp;(PHC) ones [2].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAddressing the large and growing burden of mental, neurological, and substance use (MNS) disorders at the population level via scaled-up implementation of evidence-based treatment and prevention has been repeatedly essential over the past decade, and it can be expected to place new resource demands on the health systems of LMICs [4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Iran, about three percent of health care expenditure is allocated to mental health [5]. There are 20 mental health workers per 100,000 Iranians as for 2017 and there was a significant increase compared to 11 per 100,000 population in 2011. The breakdown according to profession is as follows: psychiatrists (2.2 per 100,000), child psychiatrists ( 0.15 per 100,000) , other medical doctors, not specialized in psychiatry (0.63 per 100,000), nurses (9.45 per 100,000), psychologists (5.17 per 100,000), social workers (1.51 per 100,000), occupational therapists (1.01 per 100,000) and speech therapist ( 0.63 per 100,000) . Nearly 5,192 in 100,000 of the general population visit outpatient facilities, mostly community-based facilities, while there are about 28.5 beds per 100,000 populations, in various settings including community-based facilities and hospitals\u0026nbsp;[6].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the transition of mental health care in Iran within about two decades, from introducing basic mental health care in PHC to the experience of community-based mental health centers (CMHC) for urban areas [7], a new socio-mental health service model, with two basic and advanced service strata, has been so far proposed.\u003c/p\u003e\n\u003cp\u003eThe first mental health program was piloted from 1992 to 1994 and after more than two decades, it now covers 18 million (82.8%) rural residents and 10 million (21.7%) citizens in urban areas. The program mainly addressed severe mental health disorders, epilepsy, and mental retardation. While it has been proven successful for villages, this program is not sufficient for those residing in urban areas. In response to the need of urban dwellers, the structure of CMHC for urban areas was designed to target those with neurotic disorders including depression and anxiety as well as severe mental disorders such as schizophrenia, bipolar disorder, and suicide attempts [8].\u003c/p\u003e\n\u003cp\u003eThe new socio-mental health service model is thus comprised of two levels of health services, i.e., basic and advanced mental health services. The basic level services include public education on the basics of socio-mental health skills and screening. At this level, cases with target mental conditions are recognized by community health workers and then referred to mental health specialists for further evaluations and interventions. Using an inter-sectorial approach, patients in need of social services should be referred to a relevant service provided by other organizations in order to strengthen their social support [8].\u003c/p\u003e\n\u003cp\u003eThe advanced socio-mental health services take account of facilities for mental and social emergencies and provide treatments for referrals from level one. Such services should be delivered by a collaborative care team comprised of psychologists, clinical psychiatrists, etc. at the integrated mental health settings such as PHC health centers, CMHCs, and hospitals [8].\u003c/p\u003e\n\u003cp\u003eAccordingly, scaling-up mental health services in a successful manner involves putting a range of human, physical, and other resource inputs together in order to deliver interventions and services capable of improving mental health status and related outcomes. In view of that, an essential element of evidence-based mental health service planning and scaling-up is related to an assessment of what resources are required for delivering of services to populations in need and meeting program goals [9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, this study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs to make an investment case to be considered by policy-makers for further evidence-based policy-making. The perspective chosen for this study is healthcare system, specifically ministry of health which responsible for providing mental health services through primary healthcare settings and hospitals. While healthcare perspective provides a straightforward analysis of costs and health gains for policy makers, the societal view can capture both costs and impacts in a comprehensive scale which will be more convincing once the evidence is used for budget negotiation at national level. \u0026nbsp;Although, considering social costs is often in favor of cost-effectiveness of mental health interventions [10], the societal perspective has not been taken into account as the OHT methodology does not provide technical capacity for such estimation.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Design and Tools\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was a cost-consequence analysis to examine the expected health gains as well as costs of scaling-up certain interventions to reduce the burden of mental disorders in different groups of patients suffering from anxiety, depression, bipolar disorder, and epilepsy in Iran. The scaling-up scenario was thus tested against the no scaling-up scenario with the existing level of care offered in the system. The data required for the study were collected in the first quarter of the year 2020 and the time horizon was a 10-year period from 2020 to 2030. Although the amount of services provided in the private sector is considerable and includes 75% of outpatient services [11], in this study we assumed ministry of health as the single provider in order to restrict the scope of research and gather high quality data to make precise estimations. It was therefore assumed that all the services were being provided by the government within the facilities of the Ministry of Health and Medical Education (MOHME) and the analysis was fulfilled based on its perspective.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOne Health Tool Module on MNS Disorders\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe OneHealth Tool (OHT), a software tool developed by the international costing experts from the World Health Organization (WHO) and other United Nations (UN) agencies, was employed to start this study. The mental health module of the OHT was accordingly developed in order to ensure that the national mental health development plans have been carried out within a framework of assessment of overall health system capacity and to take financial sustainability and outcomes-based planning into account [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eResearch Planning\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsulting with three main national planners at the Department of Mental Health in the MOHME who are in charge of this program, priority MNS disorders including depression, anxiety, bipolar disorder, and epilepsy were selected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe main criteria to select these interventions include 1) Provision of care within the centers affiliated by ministry of health: for instance, the drug abuse treatment was excluded as the services are mainly provided in other sectors. 2) Burden of diseases: as reflected in the introduction, these disorders are among most prevalent ones in national and global levels and 3) The inclusion of the interventions in OHT impact module: Since not all of the interventions are included in this module to estimate health impacts , we checked the available interventions and excluded ones which are not provided in impact modules and then we finalized eight interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is noteworthy that these interventions are recommended in WHO Mental Health Gap Action Program (mhGAP) guideline [13] as standard and effective interventions. So, their effectiveness is proved through RCTs and Systematic reviews which are formulated in the OHT to estimate the health impacts. Although national estimation of effectiveness would better describe the situation , it hasn\u0026rsquo;t been in the scope of this study to estimate these measures and no national studies were available too. Therefore, we relied on the global and regional evidence of effectiveness in the OHT.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, appropriate mental health care packages and scenarios, current and target coverage levels for specific intervention strategies, and scaling-up period were identified through consultations with the expert group of national planners and program managers.\u003c/p\u003e\n\u003cp\u003eFor clinical-level consideration of resource use profiles for different disorders and interventions, unit costs and prices for health care services and commodities (such as those for staff salaries, outpatient visits, and psychotropic medications), one of the pilot sites (namely, the city of Oskoo in East Azerbaijan Province) was selected. This new service model was initially implemented in three cities [14]. Although a formal evaluation was not performed to compare the process in these three pilot sites, based on the regular observations, national managers of the program believe that Oskoo is the best practice to the program, benefiting from excellent documentation and assessments. To collect these inputs, the research team, working with local team members and other national staff, identified and utilized local data sources and visited the site in a three-day tour. The data checklist adapted from the study by Chisholm [12] was also modified and used in order to facilitate and document the process of data contextualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Contextualization\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth Impacts\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe selected metric for summarizing health effects at the population level is (healthy) life years (LYs) gained (equivalent to disability-adjusted life years (DALYs) averted), where one DALY could be thought of as one YLL. (Healthy) LYs is also computed with reference to country-specific life tables that have been already built into the model, and reflect the combined time spent by the population in a particular state of health with a known degree (or free) of disability. Default disability levels in OHT were drawn from the GBD 2010 study [15]. Implementing or scaling-up an effective intervention in the population was thus modeled to reduce the time spent in a disabling state, either by reducing prevalence (e.g., by decreasing the number of new cases or increasing the remission rate), or by improving the level of functioning in people with the condition in question [12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEpidemiology\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIran has a history in mental health surveys and it is therefore possible to make use of high-quality epidemiological data from the national surveys [16, 17, 18]. However, to meet age-stratified data sheets of the OHT on the prevalence and incidence rates for all disorders, the 2017 GBD estimates available in GBD result tool (\u003ca href=\"http://ghdx.healthdata.org/gbd-results-tool\"\u003ehttp://ghdx.healthdata.org/gbd-results-tool\u003c/a\u003e) were used. The prevalence and incidence rates were extracted for the four disorders including depression, anxiety, bipolar and epilepsy and the data were sorted for male and female in 17 age groups. Then, to meet the OHT requirements for data entry, these rates were modified to cases per 1,000 population. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEstimating Resources, Costs, and Coverage Levels\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe key categories of health service costs in the OHT included drug and supply costs (e.g., daily dose of a generically produced first-line anti-psychotic or anti-epileptic medication), costs of response to ambulatory contacts by mental health or general health workers (such as psychologists, counselors, and community health workers), and costs of hospital-based outpatient/inpatient care services. In addition, program-level resource needs were identified, including overall program management and administration as well as training [12].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIntervention Costing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eResources used in terms of drug and supply, staff salaries, and outpatient visits were documented through field visits to the pilot site and the associated costs were subsequently estimated based on accounting documents available in the program management office in order to estimate the average cost of each intervention per case.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs described in the introduction of the new care model, basic package of care (e.g. basic psychosocial treatment plus medication therapy of moderate cases of anxiety/depression) were being provided in health care facilities and severe cases of those disorders in addition to all bipolar cases could be referred to the CMHCs for intensive care and social support. It is noteworthy that the WHO mhGAP guideline was practiced with slight changes in real time spent and availability of recommended drugs in the whole system of integrated mental health care in PHC.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll three levels of care (health care facility, CMHC, and general hospital (psychiatric ward)) were accordingly visited and all staff including community health workers, socio-mental health experts, general practitioners, psychologists, psychiatrists, and social workers were interviewed in order to identify activities and estimate time spent for each patient and intervention. The drug and supply list used for each intervention was also documented and the price list was acquired from the health information system (HIS) of the hospital with a particular focus on most-prescribed medications available in the primary care setting. It should be noted that drug and supply prices have the same tariffs across the country in public hospitals and the PHC network.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProgram Costing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eProgram specific costs concern the cost incurred at the national and provincial level to manage and supervise the program. Information on the program-specific staff required for scaling-up were obtained from background strategic documents of the program available at the Department of Mental Health including a unit cost study of new socio-mental program, so-called SERAJ, in the year 2018 [19]. In order to estimate the cost of supervision and auditory visits as well as necessary trainings, the district managers were interviewed in the field visit and costing parameters including transportation, trainings and allowances to take part in missions were identified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTotal Cost\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe total costs of scaling-up an intervention in a given year for a country was thus derived by multiplying resource use needs by their respective unit costs to give an average cost per case. It was then multiplied by the total number of cases, expected to receive a particular intervention (given by the prevalence of the disorder multiplied by the rate of treatment coverage of specific intervention strategies in the population), that is, total cost=population\u0026times;prevalence rate\u0026times;coverage\u0026times;treatment cost per case [12]. To estimate the costs, the expected inflation rate for the period: 2020 -2030 was applied using extrapolation based on the actual inflation rates for 2010-19. Since all the costs were calculated in Iranian Rial (IRR), to convert the costs in US$, the exchange rate for the study period was estimated through extrapolation based on the UN exchange rates for the past 10 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCoverage\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn order to estimate present and future coverage levels, we have conducted three rounds of panel discussions with three national policy makers and three provincial managers who have been in charge of this program at national and district levels. The first panel was conducted at the beginning of the research, the second one was just at the early beginning of data collection and the last one during the filed visit in the pilot site. All the estimations of coverage were made based on the population covered in each area and expected coverage in the future based on the available budget. In order to make sure about coverage levels, we re-checked measures before and after field visits and examined different scenarios. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe estimates of the baseline coverage were based on the coverage of health care facilities per population. Given the expected challenges of scaling-up the new model at the national level, a modest coverage target of 30-40% by 2030 was set for the intensive packages of care and 60-70% target coverage was considered for the basic package, which have already had 40% baseline coverage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAssumptions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the volume of services provided in the private sector was not estimated. It was assumed that all the services had been provided by the government within the facilities of MOHME. Besides the base case scenario which is provided below, we examined seven others scenarios in order to provide a sensivity analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCurrencies reported\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAt first, all the costing parameters were estimated in IRR (Iranian Rial) as local currency values were used in the context of ongoing policy dialogue, then all the cost values were converted into the US dollars for ease of interpretation and comparison. The exchange rate was captured from the UN exchange rates in June 2020 which equals to 194,881 IRR.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, the final result of cost per each health life years were also reported in Intl dollars (PPP adjusted) to provide a more realistic view while the results are compared to that of different countries. In order to convert values to Intl dollars we used the cost conversion tool developed by Campbell Collaboration (\u003ca href=\"https://eppi.ioe.ac.uk/costconversion/\"\u003ehttps://eppi.ioe.ac.uk/costconversion/\u003c/a\u003e). The underlying methods of this tool is provided in the paper published in the journal of Evidence and Policy [20]. \u0026nbsp;\u003c/p\u003e\n"},{"header":"Results","content":"\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 658.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 1: Intervention coverages (%) - \u003cem\u003eFront Loaded pattern\u003c/em\u003e \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eScale up period\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 658.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eAnxiety disorders\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eBasic psychosocial treatment and anti-depressant medication for anxiety disorders\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eIntensive psychosocial treatment and medication\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003etherapy for anxiety disorders\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 658.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eDepression\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eBasic psychosocial treatment and anti-depressant medication of first episode cases\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eIntensive psychosocial treatment and anti-depressant medication of first episode cases\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eIntensive psychosocial treatment and anti-depressant medication of moderate-severe cases on a maintenance basis\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 658.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eBipolar disorder\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eIntensive psychosocial intervention for bipolar disorder, plus mood-stabilizing medication\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 658.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eEpilepsy\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257.4pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eBasic psychosocial support, advice, and follow-up, plus anti-epileptic medication\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003e\n\u003cp\u003eAfter consulting the national managers of the program, the baseline coverage levels (2020) as well as the target ones (2030), were defined for each of the interventions. Among different scaling-up patterns available in the tool including linear, S-shaped, front-loaded, and exponential, the front-loaded interpolation pattern, recommended for middle-income countries was chosen. Front loaded interpolation is basically applying a calculation pattern to reflect an assumption that scaleup happens relatively quickly (in the first years of the projection) and then coverage increases slow down. We tend to see this kind of pattern when the building blocks are in place to roll out a new service or expand an existing one. The coverage levels for all the interventions in each year are presented in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"margin-left:-12.6pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" style=\"width: 671.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: white;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 2: Total co\u003cspan style=\"color:black;\"\u003ests\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54.45pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2020\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2021\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2022\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2023\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2024\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2025\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2026\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2027\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2028\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2029\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2030\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eTotal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54.45pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eIntervention costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e8,448,265\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e13,488,255\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e18,621,150\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e23,847,368\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e29,150,836\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e34,514,740\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e39,924,870\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e45,361,257\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e50,808,697\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e56,257,325\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e61,698,157\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e382,120,919\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54.45pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eProgram costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e141,575\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e301,207\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e424,001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e560,520\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e683,314\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e819,833\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e942,627\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e1,051,697\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e1,162,739\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e1,269,838\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e1,378,908\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54.45pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eLabor costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e31,012,194\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e42,009,848\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e53,232,422\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e64,666,007\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e76,263,942\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e87,984,733\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e99,796,025\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e111,651,997\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e123,519,471\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e135,378,198\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e147,209,639\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e972,724,477\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54.45pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eTotal costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e39,602,034\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e55,799,310\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e72,277,573\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.1pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e89,073,895\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e106,098,092\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e123,319,306\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e140,663,522\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e158,064,951\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e175,490,907\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e192,905,361\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e210,286,703\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.9pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;line-height:107%;font-family:\"Times New Roman\",serif;'\u003e1,363,581,654\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54.45pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003ePer Capita\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"12\" style=\"width: 616.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e16.42\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe total cost including both intervention and program costs for all interventions selected from the module of mental and neurological disorders are illustrated in Table 2. To note, all the cost values were converted into the US dollars for ease of interpretation and comparison, but local currency values were used in the context of ongoing policy dialogue.\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" style=\"width: 8.7in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 3: Healthy Years Gained\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0.9in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eImpact scale up\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2020\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2021\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2022\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2023\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2024\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan 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none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003e2029\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan 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15pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0.9in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eEpilepsy\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e1,691\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e3,423\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e5,199\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e7,018\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e8,879\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e10,774\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e12,698\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e14,645\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e16,610\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e18,588\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e99525\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0.9in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eTotal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e50,260\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e83,477\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e111,202\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e136,645\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e161,055\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e184,963\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e208,613\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e232,116\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e255,527\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:11px;line-height:107%;font-family: \"Times New Roman\",serif;'\u003e278,897\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52.8pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;line-height:107%;font-family:\"Times New Roman\",serif;'\u003e1,702,755\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 3, the health impacts are calculated in terms of (healthy) LYs gained for 2020-30, after adjusting the prevalence and incidence rates for each disorder in the NCD impact module. Depression has the biggest share in the health impact, as it is the most prevalent mental disorder in Iran. In total, \u003cstrong\u003e1,702,755\u003c/strong\u003e (healthy) LYs were expected to be gained via scaling-up the program at national levels. Considering the total \u003cstrong\u003e1,363,581,654\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eUS dollars cost, each (healthy) LY gained will cost around \u003cstrong\u003e801\u003c/strong\u003e US dollars.\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"margin-left:9.9pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width: 648.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 4: Sensivity Analysis\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eScenarios\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eBase case(Front loaded)\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 145.4pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eScale Up Pattern\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 145.3pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eEpidemiologic data CIs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 217.95pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eExpected Coverage Levels\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eExponential\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eLinear\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eLower\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eUpper\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eCoverage 1\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eCoverage 2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eCoverage 3\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eIntervention costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e382,120,919\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e390,611,079\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e387,772,875\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e305,783,940\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e476,662,810\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e392,627,220\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e448,247,779\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e372,911,819\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eProgram costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8,736,258\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eLabor costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e972,724,477\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e994,357,774\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e987,228,401\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e778,324,069\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,213,512,516\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,014,058,490\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,065,250,321\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e934,160,222\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eTotal costs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,363,581,654\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,393,705,112\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,383,737,535\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,092,844,267\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,698,911,584\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,415,421,968\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,522,234,357\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,315,808,299\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width: 648.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eImpact scale up\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eDepression\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e1,147,236\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e753,131\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e957,688\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e934,294\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e1,403,864\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,105,159\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,439,832\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,105,371\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eAnxiety\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New 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style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e324,450\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e316,006\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e418,867\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e310,894\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e435,672\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e311,346\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eBipolar\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e93,802\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e38,658\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e67,133\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e65,494\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e130,647\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e93,802\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e128,165\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e93,802\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eEpilepsy\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e99,525\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e88,300\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e94,216\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e61,126\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e150,542\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e65,234\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e99,525\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e65,716\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eTotal Impact\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e1,702,755\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e1,162,396\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e1,443,487\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e1,376,920\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e2,103,920\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,575,089\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e2,103,194\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1,576,235\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eCost per a Healthy LY (US$)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e801\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e1199\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e959\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e794\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e807\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e899\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e724\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e835\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.55pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(191, 191, 191);padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;color:black;'\u003eCost per a Healthy LY (Intl$/ PPP Adjusted)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e7714\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e11548\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.7pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e9236\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e7647\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e7772\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8658\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e6973\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72.65pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:11px;line-height:107%;\"\u003e8042\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eIn order to provide a sensivity analysis, we have examined three sets of scenarios changing the scale up patterns, investigating the lower and upper bound of Confidence Intervals (CIs) for prevalence and incidence rates and finally changing the coverage levels.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs shown in the table 4, the cost per a healthy LY changes from 1199 US$ in exponential pattern to 959 in linear one. Based on the health system development level in Iran, the front-loaded pattern, recommended for middle income countries, is selected and other scenarios are tested against it.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThen, in the next set of scenarios, the epidemiological data, obtained from GBD estimates, were changed using the CIs of reported prevalence and incidence rates resulting in a range of 794 to 807 US dollars per each healthy LY gained.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, we have examined different coverage levels as the main driver for costs and impacts. In the scenario \u0026ldquo;Coverage 1\u0026rdquo;, we have changed the existing coverage of basic interventions from 40% to 50% while in the \u0026ldquo;Coverage 2\u0026rdquo; scenario the target level for intensive care was adjusted for 40% instead of 30% in base case scenario. Moreover, in the scenario \u0026ldquo;Coverage 3\u0026rdquo; the target level for the basic package were reduced considering 60% level of coverage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the WHO criteria [21], all of these values ranged from 724 to 1199 US$ obtained through eight different scenarios were considered as cost-effective.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the face of large and increasing burden of mental diseases and treatment gaps existing in Iran, a new socio-mental health service model was introduced to the mental health system of this country. This program, available in PHC settings, could significantly contribute to achieving the goals of the UHC for the MNS disorders in terms of financial protection and service provision. This study was further concerned with informing national policy-makers about resource needs and costs of scaling-up such mental health services in national level.\u003c/p\u003e\n\u003cp\u003eThe OHT methodology used by Chisholm [12] was followed in this study. In comparison with their estimation for five LMICs, the results of this study indicated that the resource needs for scaling-up mental health services did not need to be substantial. Although differences in health system development, service packages, and costing requirements make it much difficult to compare results between various countries in such studies, the cost estimated here for Iran in the base case scenario was 801 US dollars in terms of cost per (healthy) LY gained. This value was far less than what was estimated for South Africa, around 18,000 US dollars, whose per capita income was comparable to that of Iran as a middle-income country. This estimation was somehow analogous to that of India with 761 US dollars per (healthy) LY gained from scaling-up their mental health program [12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn another\u0026nbsp;cost-effectiveness analysis of an essential mental health intervention package in Nigeria [22], the cost per each DALY averted for a package of care including depression, schizophrenia, epilepsy, and hazardous alcohol use was estimated 320 US dollars. In addition, the study of cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya [23] estimated the cost of a DALY averted around Int$ 727 from the health system perspectives. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn a more recent study in Ethiopia,\u0026nbsp;a cost-effectiveness analysis about scaling-up essential neuropsychiatric services for treatments of depression, schizophrenia, bipolar disorder and epilepsy were performed [24]. Based on the results of this study, treatment of epilepsy with a first-generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457\u0026ndash;1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168\u0026ndash;3739 per DALY adverted). Generally, the cost of bipolar and schizophrenia treatments are two or three times higher than that of depression and epilepsy which often don\u0026rsquo;t need hospitalization and specialist services. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the present study, through examining different scenarios, it was shown that achieving more coverage level in new socio-mental health in terms of increased level of intensive care package (increasing the expected level from 30% to 40%) could significantly reduce the cost per each (healthy) LY gained from 801 US$ in base case to 724 US$ in respective scenario. It means that by expanding this new service model aimed at urban population, more (healthy) LY will be gained and the cost per each (healthy) LY will decrease. Comparisons made between different scenarios show that introduction of this new service model in urban areas is cost-effective while the basic package of care is well-developed in rural areas. It is noteworthy that all the health gains based on the base case would cost 16.4 US dollar per capita in the next ten years from the health system perspective which is not substantial compared to the health expenditure per capita equal to 484 US dollars as for 2018 (\u003ca href=\"https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=IR\"\u003ehttps://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=IR\u003c/a\u003e ) and can in turn greatly increase the access to the mental health care by citizens and is considered an important step forward in order to achieve universal health coverage in mental health. \u0026nbsp;In addition, as reported in an economic analysis study [25] based on the unit costs of this program in the pilot level, considering 116 570 people in order to be screened and treated within this model , the per capita cost was estimated 5.56 US dollar which seems comparable to our estimation as we did a prospective estimation in the national level for the next ten years considering inflation rate. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, based on 2014 atlas of mental health [26], the per capita mental health cost in Iran is reported 1.73 US dollars while in the same year the health expenditure per capita equals to 432 US dollars. This figure demonstrates how neglected is the mental health sector and how this new service model could contribute to greater access and improved mental health with relatively small amount of funds. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, based on the WHO criteria for cost-effectiveness threshold [21], cost per (healthy) LY gained (i.e., DALY averted) was considered very cost-effective if it was less than a gross domestic product (GDP) per capita in a specified country. The estimation of 801 US dollars (7714 Intl dollars) per (healthy) LY gained through the scaling-up period of the new socio mental health care could be regarded cost-effective as well given the GDP per capita of 5550 US dollars (12,937 Intl dollars) for Iran in 2018 (2019) (\u003ca href=\"https://data.worldbank.org/indicator/NY.GDP.PCAP.PP.CD?locations=IR\"\u003ehttps://data.worldbank.org/indicator/NY.GDP.PCAP.PP.CD?locations=IR\u003c/a\u003e ). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, the health returns on such an investment are substantial. Such information on the costs and health impacts of scaling-up could further provide important evidence that could be used in dialogues with health planners and policy-makers at the national level, particularly in the context of increased policy attention to the rising burden of mental and neurological disorders.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar [5,26], which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar for scaling up this comprehensive mental health service model besides previous studies (19, 25) reporting 5.56 US dollar per each person, can convince high-level policy-makers to increase the share of mental health budget accordingly. \u0026nbsp;Using the OHT strategic planning reflecting on the expected health gains and the associated costs, could help policy-makers with evidence-informed policy- making to prioritize cost-effective interventions and to improve allocative efficiency. The present study provided a timely analysis as the Department of Mental Health in Iran sought to implement an ambitious plan of mental health scaling-up across the country, collaborating with the MOHME and the Ministry of Interior. Therefore, this work could make a useful contribution to state-level deliberations on the implementation of this plan at national level. Expanding such works beyond the mental health to all non-communicable diseases (NCDs) and making comparisons within and between specific packages of cares can be thus great evidence while the programs are developing at different departments aimed to be scaled-up at national and sub-national levels.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eWorking with the OHT through different modules can be a challenging job with hundreds of parameters to be revised and updated. A broad concern is also related to the available national evidence on a number of domains. These include epidemiological data on the burden of the MNS disorders, extent of current coverage and expenditure, as well as evidence base for locally adapted cost-effective interventions. While regional and global default estimates are available, the tool developers strongly encourage updating parameters with national estimates.\u003c/p\u003e\n\u003cp\u003eTo update the prevalence and incidence rates, the GBD estimates were accordingly used as the last national mental health survey of Iran did not include estimates on the incidence rates while the prevalence rates had been also limited to major depression and anxiety. In case of cost- effectiveness of interventions and transition rates (e.g. remission and mortality rates), the default OHT rates were employed, since there were no national estimates or even studies investigating such parameters.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUniversal Health Coverage (UHC)\u003c/p\u003e\n\u003cp\u003eYears of (healthy) Life Lost (YLL)\u003c/p\u003e\n\u003cp\u003eGlobal Burden of Disease (GBD)\u003c/p\u003e\n\u003cp\u003eLow- and Middle-Income Countries (LMICs)\u003c/p\u003e\n\u003cp\u003eUnited States (US)\u003c/p\u003e\n\u003cp\u003eNational Institute of Mental Health (NIMH)\u003c/p\u003e\n\u003cp\u003ePrimary Health Care (PHC)\u003c/p\u003e\n\u003cp\u003eMental, Neurological, and Substance use (MNS)\u003c/p\u003e\n\u003cp\u003eCommunity-Based Mental Health Centers (CMHC)\u003c/p\u003e\n\u003cp\u003eMinistry of Health and Medical Education (MOHME)\u003c/p\u003e\n\u003cp\u003eOne Health Tool (OHT)\u003c/p\u003e\n\u003cp\u003eWorld Health Organization (WHO)\u003c/p\u003e\n\u003cp\u003eUnited Nations (UN)\u003c/p\u003e\n\u003cp\u003eDisability-Adjusted Life Years: DALYs\u003c/p\u003e\n\u003cp\u003eMental Health Gap Action Program (mhGAP)\u003c/p\u003e\n\u003cp\u003eHealth Information System (HIS)\u003c/p\u003e\n\u003cp\u003eConfidence Intervals (CIs)\u003c/p\u003e\n\u003cp\u003eNon-Communicable Diseases (NCDs)\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch4\u003eEthics approval and consent to participate\u003c/h4\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003ch4\u003eConsent for publication\u003c/h4\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003ch4\u003eAvailability of data and materials\u003c/h4\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch4\u003eCompeting interests\u003c/h4\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch4\u003eFunding\u003c/h4\u003e\n\u003cp\u003eThis study is supported financially by Iran University of Medical Sciences and is also approved by the ethical committee of the university under the research ethic code: IR.IUMS.REC.1397.050\u003c/p\u003e\n\u003ch4\u003eAuthors\u0026apos; contributions\u003c/h4\u003e\n\u003cp\u003eSHJ have proposed the topic and the study was designed by SHJ and AR. The study protocol was finalized in collaboration with MML and AH. The epidemiological data was gathered by SHJ, MML and AH while SHJ, AR and BD accomplished the costing part. The data were analyzed by SHJ and then critically interpreted by AR, MML and AH. SHJ drafted the paper and all authors reviewed it accordingly and have provided their input.\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eAcknowledgements\u003c/h4\u003e\n\u003cp\u003eThis study is part of the PhD thesis by Ms. Seyede Sedighe Hosseini Jebeli supported by Iran University of Medical Sciences with grant number IUMS/SHMIS/1397-2-37-12423. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe would also like to express our sincere gratitude to Mr Vahab Asl Rahimi, Director of Mental Health of east Azarbaijan Province Health center, and Mrs Azam Hemmati, Expert of Mental Health and all colleagues in Tabriz University of Medical Sciences who supported us both technically and administratively in order to collect data to accomplish this project. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Investing in mental health: evidence for action.\u003c/li\u003e\n\u003cli\u003ePatel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, Chisholm D, Collins PY, Cooper JL, Eaton J, Herrman H. The Lancet Commission on global mental health and sustainable development. The Lancet. 2018 Oct 27;392(10157):1553-98.\u003c/li\u003e\n\u003cli\u003eCaddick H, Horne B, Mackenzie J, Tilley H. Investing in mental health in low-income countries. London: Overseas Development Institute. 2016 Dec.\u003c/li\u003e\n\u003cli\u003eChisholm D, Docrat S, Abdulmalik J, Alem A, Gureje O, Gurung D, Hanlon C, Jordans MJ, Kangere S, Kigozi F, Mugisha J. Mental health financing challenges, opportunities and strategies in low-and middle-income countries: findings from the Emerald project. BJPsych open. 2019 Sep;5(5).\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. WHO-AIMS report on mental health system in the Islamic Republic of Iran. Tehrran, Iran: World Health Organization\u0026mdash;Assessment Instrument for Mental Health Systems. 2006.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Mental health atlas 2017: resources for mental health in the Eastern Mediterranean Region.\u003c/li\u003e\n\u003cli\u003eSharifi V, Hajebi A, Damari B, Mohammadjafari A. Specialized Outpatient Services in the SERAJ Program: Community Mental Health Centers (CMHCs). Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):32-8.\u003c/li\u003e\n\u003cli\u003eDamari B, Alikhani S, Riazi-Isfahani S, Hajebi A. Transition of mental health to a more responsible service in Iran. Iranian journal of psychiatry. 2017 Jan;12(1):36.\u003c/li\u003e\n\u003cli\u003eChisholm D, Burman-Roy S, Fekadu A, Kathree T, Kizza D, Luitel NP, Petersen I, Shidhaye R, De Silva M, Lund C. Estimating the cost of implementing district mental healthcare plans in five low-and middle-income countries: the PRIME study. The British Journal of Psychiatry. 2016 Jan;208(s56): s71-8.\u003c/li\u003e\n\u003cli\u003eDuevel JA, Hasemann L, Pe\u0026ntilde;a-Longobardo LM, Rodr\u0026iacute;guez-S\u0026aacute;nchez B, Aranda-Reneo I, Oliva-Moreno J, L\u0026oacute;pez-Bastida J, Greiner W. Considering the societal perspective in economic evaluations: a systematic review in the case of depression. Health economics review. 2020 Dec;10(1):1-9.\u003c/li\u003e\n\u003cli\u003eDamari B, Mafimoradi S. Intersectoral expectations for promoting mental health: A qualitative case study of Islamic Republic of Iran. International journal of preventive medicine. 2019;10.\u003c/li\u003e\n\u003cli\u003eChisholm D, Heslin M, Docrat S, Nanda S, Shidhaye R, Upadhaya N, Jordans M, Abdulmalik J, Olayiwola S, Gureje O, Kizza D. Scaling-up services for psychosis, depression and epilepsy in sub-Saharan Africa and South Asia: development and application of a mental health systems planning tool (OneHealth). Epidemiology and Psychiatric Sciences. 2017 Jun;26(3):234-44.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. mhGAP: Mental Health Gap Action Programme: scaling up care for mental, neurological and substance use disorders. Geneva: World Health Organization; 2008.\u003c/li\u003e\n\u003cli\u003eDamari B, Asgardoon MH. Evaluation of the Community Action Package in Iran's Mental and Social Health Services Model (the SERAJ Program). Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):12-22.\u003c/li\u003e\n\u003cli\u003eSalomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, Mokdad A, Begum N, Shah R, Karyana M, Kosen S, Farje MR. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 15;380(9859):2129-43.\u003c/li\u003e\n\u003cli\u003eNoorbala AA, Faghihzadeh S, Kamali K, Yazdi SA, Hajebi A, Mousavi MT, Akhondzadeh S, Faghihzadeh E, Nouri B. Mental health survey of the Iranian adult population in 2015. Archives of Iranian medicine. 2017 Mar 1;20(3):0-.\u003c/li\u003e\n\u003cli\u003eSharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, Rahimi-Movaghar A. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Archives of Iranian medicine. 2015 Feb 1;18(2):0-.\u003c/li\u003e\n\u003cli\u003eRahimi-Movaghar A, Sharifi V, Motevalian A, Amin-Esmaeili M, Hadjebi A, Rad Goodarzi R. Iranian National Mental Health Survey: prevalence, severity and costs of mental disorders and service utilization (IranMHS). Tehran: Mehrsa. 2014.\u003c/li\u003e\n\u003cli\u003eDamari B, Hajebi A, Abolhallaje M, Najafi B. How Much Should We Pay to Deliver Comprehensive Mental Health Services? Experiences from Iran. Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):39-45.\u003c/li\u003e\n\u003cli\u003eShemilt I, Thomas J, Morciano M. A web-based tool for adjusting costs to a specific target currency and price year. Evidence \u0026amp; Policy: A Journal of Research, Debate and Practice. 2010 Jan 1;6(1):51-9.\u003c/li\u003e\n\u003cli\u003eBertram MY, Lauer JA, De Joncheere K, Edejer T, Hutubessy R, Kieny MP, Hill SR. Cost\u0026ndash;effectiveness thresholds: pros and cons. Bulletin of the World Health Organization. 2016 Dec 1;94(12):925.\u003c/li\u003e\n\u003cli\u003eGureje O, Chisholm D, Kola L, Lasebikan V, Saxena S. Cost-effectiveness of an essential mental health intervention package in Nigeria. World Psychiatry. 2007 Feb;6(1):42.\u003c/li\u003e\n\u003cli\u003ede Menil V, Knapp M, McDaid D, Raja S, Kingori J, Waruguru M, Kippen Wood S, Mannarath S, Lund C. Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya. Psychological medicine. 2015 May 21;45(12):2747-56.\u003c/li\u003e\n\u003cli\u003eStrand KB, Chisholm D, Fekadu A, Johansson KA. Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis. Health policy and planning. 2016 May 1;31(4):504-13.\u003c/li\u003e\n\u003cli\u003eDamari B, Vosoogh-Moghaddam A, Hajebi A, Amirhoseiny S. Iran's Comprehensive Mental and Social Health Services (the SERAJ Program): Economic Considerations and Financial Policy Recommendations. Iranian Journal of Psychiatry. 2020 Dec 5;15(Supple 1):59-64.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Mental health Atlas country profile 2014.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-mental-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jmhs","sideBox":"Learn more about [International Journal of Mental Health Systems](http://ijmhs.biomedcentral.com/)","snPcode":"13033","submissionUrl":"https://submission.nature.com/new-submission/13033/3","title":"International Journal of Mental Health Systems","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mental Health, Economic evaluation, Universal Health Coverage","lastPublishedDoi":"10.21203/rs.3.rs-52097/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-52097/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs.\u003c/p\u003e\u003cp\u003eMethods: This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of medicines, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case.\u0026nbsp;\u003c/p\u003e\u003cp\u003eResults:\u0026nbsp;The health impacts are calculated in terms of healthy life years gained, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in basic scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5,550 US dollars for Iran.\u003c/p\u003e\u003cp\u003eConclusions:\u0026nbsp;Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Scaling-Up a New Socio-Mental Health Service Model in Iran to Reduce Burden of Neuropsychiatric Disorders: An Economic Evaluation Study","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2021-01-18 12:49:43","doi":"10.21203/rs.3.rs-52097/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2021-03-20T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-03-17T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2021-03-02T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-02-16T00:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-02-15T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-01-02T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-01-01T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-01-01T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-mental-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jmhs","sideBox":"Learn more about [International Journal of Mental Health Systems](http://ijmhs.biomedcentral.com/)","snPcode":"13033","submissionUrl":"https://submission.nature.com/new-submission/13033/3","title":"International Journal of Mental Health Systems","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-08-07 15:35:31","doi":"10.21203/rs.3.rs-52097/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-11-22T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-19T00:00:00+00:00","index":2,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-18T12:00:00+00:00","index":3,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-09-28T12:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2020-08-16T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-08-15T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-08-15T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-08-06T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-08-05T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-08-05T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-08-04T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-mental-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jmhs","sideBox":"Learn more about [International Journal of Mental Health Systems](http://ijmhs.biomedcentral.com/)","snPcode":"13033","submissionUrl":"https://submission.nature.com/new-submission/13033/3","title":"International Journal of Mental Health Systems","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55080ed0-b843-43b1-a73c-4900d737b0cc","owner":[],"postedDate":"January 18th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":260565,"name":"Health Policy"}],"tags":[],"updatedAt":"2021-06-09T23:53:09+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-18 12:49:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-52097","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-52097","identity":"rs-52097","version":["v2"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}