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Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya

Published online by Cambridge University Press:  21 May 2015

V. de Menil ,
M. Knapp ,
D. McDaid ,
S. Raja ,
J. Kingori ,
M. Waruguru ,
S. K. Wood ,
S. Mannarath  and
C. Lund
V. de Menil*
Affiliation:
Department of Social Policy, London School of Economics and Political Science, UK
M. Knapp
Affiliation:
Personal Social Services Research Unit, London School of Economics and Political Science, UK
D. McDaid
Affiliation:
Personal Social Services Research Unit, London School of Economics and Political Science, UK
S. Raja
Affiliation:
Policy and Practice Directorate, BasicNeeds, India
J. Kingori
Affiliation:
BasicNeeds Kenya
M. Waruguru
Affiliation:
BasicNeeds Kenya
S. K. Wood
Affiliation:
Policy and Practice Directorate, BasicNeeds, India
S. Mannarath
Affiliation:
Policy and Practice Directorate, BasicNeeds, India
C. Lund
Affiliation:
Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
*
*Address for correspondence: V. de Menil, PhD, Department of Social Policy, London School of Economics and Political Science, London, UK (Email: victoria.demenil@gmail.com)
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Abstract

Background

The treatment gap for serious mental disorders across low-income countries is estimated to be 89%. The model for Mental Health and Development (MHD) offers community-based care for people with mental disorders in 11 low- and middle-income countries.

Method

In Kenya, using a pre-post design, 117 consecutively enrolled participants with schizophrenia-spectrum and bipolar disorders were followed-up at 10 and 20 months. Comparison outcomes were drawn from the literature. Costs were analysed from societal and health system perspectives.

Results

From the societal perspective, MHD cost Int$ 594 per person in the first year and Int$ 876 over 2 years. The cost per healthy day gained was Int$ 7.96 in the first year and Int$ 1.03 over 2 years – less than the agricultural minimum wage. The cost per disability-adjusted life year averted over 2 years was Int$ 13.1 and Int$ 727 from the societal and health system perspectives, respectively, on par with antiretrovirals for HIV.

Conclusions

MHD achieved increasing returns over time. The model appears cost-effective and equitable, especially over 2 years. Its affordability relies on multi-sectoral participation nationally and internationally.

Keywords

Africacommunity mental healtheconomic outcomesglobal mental healthsevere mental disorders
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 13 , October 2015 , pp. 2747 - 2756
Copyright
Copyright © Cambridge University Press 2015 

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