Costs and cost-effectiveness of Shamiri, a brief, layperson-delivered intervention for Kenyan adolescents: a randomized controlled trial

BMC Health Services Research

Research

Natalie E. Johnson¹  Corinne N. Kacmarek²  Brian T. Yates³  John R. Weisz⁴  Christine Wasanga⁵  Tom L. Osborn⁶ 

[1] Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Totengässlein 3, 4051, Basel, Switzerland;Department of Psychology, American University, 4400 Massachusetts Ave NW, 20016, Washington, DC, USA;Department of Psychology, American University, 4400 Massachusetts Ave NW, Asbury Building Room 321, 20016-8062, Washington, DC, USA;Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, 02138, Cambridge, MA, USA;Department of Psychology, Kenyatta University, Box 43844, 00100, Nairobi, Kenya;Shamiri Institute, 13th Floor, Pioneer Point (CMS Africa), Chania Avenue, Nairobi, Kenya;

关键词: Cost-effectiveness;    Global mental health;    Adolescents;    Lay provider;    Depression;    Anxiety;    School-based;    Health promotion;    Low and middle income country;   

DOI  :  10.1186/s12913-023-09856-z

 received in 2023-03-05, accepted in 2023-07-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundLow- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group– and school–based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation.MethodsWe estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder questionnaire (GAD-7) at treatment termination and 7-month follow-up using two definitions of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat.ResultsBase case cost assumptions estimated that delivering Shamiri cost $15.17 (in 2021 U.S. dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between $48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up.ConclusionsShamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the training time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only four weekly sessions instead of the traditional 12–16 weekly sessions necessary for gold-standard cognitive behavioral therapy. The school setting, group format, and economic context of a LMIC influenced the cost per student; however, broader conclusions about the cost-effectiveness of Shamiri have yet to be determined due to limited economic evaluations of mental health programs in LMICs.Trial registrationThis study was registered prior to participant enrollment in the Pan-African Clinical Trials Registry (PACTR201906525818462), registered 20 Jun 2019, https://pactr.samrc.ac.za/Search.aspx.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023