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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*
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)

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

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References

Alem, A, Kebede, D, Fekadu, A, Shibre, T, Fekadu, D, Beyero, T, Medhin, G, Negash, A, Kullgren, G (2009). Clinical course and outcome of schizophrenia in a predominantly treatment-naïve cohort in rural Ethiopia. Schizophrenia Bulletin 35, 646654.Google Scholar
Bekele, YY, Flisher, A, Alem, A, Baheretebeb, Y (2009). Pathways to psychiatric care in Ethiopia. Psychological Medicine 39, 475.Google Scholar
Chandra, PS, Kommu, JVS, Rudhran, V (2012). Schizophrenia in women and children: a selective review of literature from developing countries. International Review of Psychiatry 24, 467482.CrossRefGoogle ScholarPubMed
Chipimo, PJ, Fylkesnes, K (2010). Comparative validity of screening instruments for mental distress in Zambia. Clinical Practice and Epidemiology in Mental Health 6, 4.Google Scholar
Chisholm, D (2005). Choosing cost-effective interventions in psychiatry: results from the CHOICE programme of the World Health Organization. World Psychiatry 4.Google Scholar
Chisholm, D, Gureje, O, Saldivia, S, Villalón Calderón, M, Wickremasinghe, R, Mendis, N, Ayuso-Mateos, JL, Saxena, S (2008). Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis. Bulletin of the World Health Organization 86, 542551.Google Scholar
Chisholm, D, Van Ommeren, M, Ayuso-Mateos, JL, Saxena, S (2005). Cost-effectiveness of clinical interventions for reducing the global burden of bipolar disorder. British Journal of Psychiatry 187, 559.Google Scholar
Goldberg, D, Oldehinkel, T, Ormel, J (1998). Why GHQ threshold varies from one place to another. Psychological Medicine 28, 915921.CrossRefGoogle Scholar
Gureje, O, Obikoya, B (1990). The GHQ-12 as a screening tool in a primary care setting. Social Psychiatry and Psychiatric Epidemiology 25, 276280.CrossRefGoogle Scholar
Haro, JM, Novick, D, Bertsch, J, Karagianis, J, Dossenbach, M, Jones, PB (2011). Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. The British Journal of Psychiatry 199, 194201.Google Scholar
Helander, E (1993). Prejudice and Dignity: an Introduction to Community-Based Rehabilitation. United Nations Development Programme.Google Scholar
Institute of Health Metrics and Evaluation (2010). GBD 2010 Disability Weights.Google Scholar
Jääskeläinen, E, Juola, P, Hirvonen, N, McGrath, JJ, Saha, S, Isohanni, M, Veijola, J, Miettunen, J (2012). A systematic review and meta-analysis of recovery in schizophrenia. Schizophrenia Bulletin sbs 130.Google Scholar
Jenkins, R, Njenga, F, Okonji, M, Kigamwa, P, Baraza, M, Ayuyo, J, Singleton, N, McManus, S, Kiima, D (2012). Psychotic symptoms in Kenya–prevalence, risk factors, and relationship with common mental disorders. International Journal of Environmental Research and Public Health 9, 17481756.Google Scholar
Jenkins, R, Othieno, C, Okeyo, S, Kaseje, D, Aruwa, J, Oyugi, H, Bassett, P, Kauye, F (2013). Short structured general mental health in service training programme in Kenya improves patient health and social outcomes but not detection of mental health problems-a pragmatic cluster randomised controlled trial. International Journal of Mental Health Systems 7, 25.Google Scholar
Kebede, D, Alem, A, Shibre, T, Negash, A, Deyassa, N, Beyero, T, Medhin, G (2005). Short-term symptomatic and functional outcomes of schizophrenia in Butajira, Ethiopia. Schizophrenia Research 78, 171185.Google Scholar
Kelly, MJ, Dunstan, FD, Lloyd, K, Fone, DL (2008). Evaluating cutpoints for the MHI-5 and MCS using the GHQ-12: a comparison of five different methods. BMC Psychiatry 8, 10.Google Scholar
Kiima, D, Jenkins, R (2010). Mental health policy in Kenya-an integrated approach to scaling up equitable care for poor populations. International Journal of Mental Health Systems 4, 18.Google Scholar
Lora, A, Kohn, R, Levav, I, Mcbain, R, Morris, J, Saxena, S (2012). Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low-and middle-income countries. Bulletin of the World Health Organization 90, 4754B.Google Scholar
Lund, C, Waruguru, M, Kingori, J, Kippen Wood, S, Breuer, E, Mannarath, S, Raja, S (2012). Outcomes of the mental health and development model in rural Kenya: a 2-year prospective cohort intervention study. International Health 5, 4350.Google Scholar
Mccabe, C, Thomas, K, Brazier, J, Coleman, P (1996). Measuring the mental health status of a population: a comparison of the GHQ-12 and the SF-36 (MHI-5). British Journal of Psychiatry 169, 516521.Google Scholar
Mccrone, P, Knapp, M, Proudfoot, J, Cavanagh, K, Shapiro, DA, Ilson, S, Gray, JA, Goldberg, D, Mann, A, Marks, I (2004). Cost-effectiveness of computerised cognitive–behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry 185, 5562.Google Scholar
Mosaku, KS, Fatoye, FO, Komolafe, M, Lawal, M, Ola, BA (2006). Quality of life and associated factors among adults with epilepsy in Nigeria. The International Journal of Psychiatry in Medicine 36, 469481.Google Scholar
Murthy, R, Kishore Kumar, K, Chisholm, D, Thomas, T, Sekar, K, Chandrashekar, C (2005). Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs. Psychological Medicine 35, 341351.Google Scholar
Njenga, F (2000). Depression in Kenyan professional women. International journal of Clinical Psychopharmacology 15 (Suppl. 3), S35S36.Google ScholarPubMed
Ogundipe, OA, Olagunju, AT, Adeyemi, JD (2014). Suicidal ideation among attendees of a West African HIV clinic. Archives of Suicide Research.Google Scholar
Raja, S, Underhill, C, Shrestha, P, Sunder, U, Mannarath, S, Wood, SK, Patel, V (2012). Integrating Mental health and development: a case study of the BasicNeeds Model in Nepal. PLoS Medicine 9, e1001261.Google Scholar
Ran, M, Xiang, M, Huang, M, Shan, Y (2001). Natural course of schizophrenia: 2-year follow-up study in a rural Chinese community. British Journal of Psychiatry 178, 154.Google Scholar
Rushby, JF, Hanson, K (2001). Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis. Health Policy and Planning 16, 326331.Google Scholar
Salomon, JA, Vos, T, Hogan, DR, Gagnon, M, Naghavi, M, Mokdad, A, Begum, N, Shah, R, Karyana, M, Kosen, S (2013). Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 380, 21292143.Google Scholar
Su, TT, Sanon, M, Flessa, S (2007). Assessment of indirect cost-of-illness in a subsistence farming society by using different valuation methods. Health Policy 83, 353362.Google Scholar
Teferra, S, Shibre, T, Fekadu, A, Medhin, G, Wakwoya, A, Alem, A, Kullgren, G, Jacobsson, L (2011). Five-year mortality in a cohort of people with schizophrenia in Ethiopia. BMC Psychiatry 11, 165.Google Scholar
Thirthalli, J, Venkatesh, B, Kishorekumar, K, Arunachala, U, Venkatasubramanian, G, Subbakrishna, D, Gangadhar, B (2009). Prospective comparison of course of disability in antipsychotic treated and untreated schizophrenia patients. Acta Psychiatrica Scandinavica 119, 209217.Google Scholar
Ware, JE Jr, Sherbourne, CD (1992). The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection. Medical Care 30, 473483.CrossRefGoogle ScholarPubMed
Whoqol Group (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine 28, 551558.Google Scholar
Williams, D, Herman, A, Stein, D, Heeringa, S, Jackson, P, Moomal, H, Kessler, R (2008). Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study. Psychological Medicine 38, 211.CrossRefGoogle ScholarPubMed
WHO (2010). Measuring Health and Disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0. World Health Organization: Geneva.Google Scholar