Value in health regional issues · 2025
Cost and Budget Impact of Layering Depression Care Onto Existing HIV and Noncommunicable Disease Care Services in Western Kenya.
СтатьяНазвание и аннотация: Перевод в очереди
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Yego Faith, Sawe Sharon, Osetinsky Brianna, Wilson-Barthes Marta, Galárraga Omar
Аннотация
OBJECTIVES: The World Health Organization Mental Health Action Plan aims to increase mental healthcare coverage by half, by 2030. Reaching this target requires context-specific financial assessments. We estimated the cost and budget impact of integrating depression care into HIV, diabetes, and hypertension care programs in county-level health facilities in Kenya.
METHODS: We modeled the additional health system costs to provide depression care within chronic disease programs in 6 counties in western Kenya. We estimated per-patient-per-visit costs under 4 scenarios: a facility-based additive scenario; 2 economies of scale and scope scenarios: group session psychotherapy (GSP) delivered by a trained provider within a group of 5 to 10 patients, with and without artistic therapy; and a community-based task-shifting scenario with chronic disease care provided by psychiatry nurses. For each scenario, we estimated the annual budget impact of increasing service coverage for depression to 50% of each county's eligible population.
RESULTS: Offering facility-based GSP without artistic therapy was the least expensive scenario in all counties, with a pooled median per-patient cost of $6.74 (95% CI 6.08-7.40) per depression care visit. Facility-based GSP with artistic therapy was the most expensive scenario with a median per-patient-per-visit cost of $9.79 (8.83-10.7). An additional 3.54% (3.36-3.72) of 2023 county health budgets would be needed to increase mental health service coverage by 50% by 2030.
CONCLUSIONS: Integrating facility-based GSP within chronic disease care platforms offers a low-cost strategy for depression care provision. Reaching mental health service targets in Kenya may require 3% more of current health budgets.
METHODS: We modeled the additional health system costs to provide depression care within chronic disease programs in 6 counties in western Kenya. We estimated per-patient-per-visit costs under 4 scenarios: a facility-based additive scenario; 2 economies of scale and scope scenarios: group session psychotherapy (GSP) delivered by a trained provider within a group of 5 to 10 patients, with and without artistic therapy; and a community-based task-shifting scenario with chronic disease care provided by psychiatry nurses. For each scenario, we estimated the annual budget impact of increasing service coverage for depression to 50% of each county's eligible population.
RESULTS: Offering facility-based GSP without artistic therapy was the least expensive scenario in all counties, with a pooled median per-patient cost of $6.74 (95% CI 6.08-7.40) per depression care visit. Facility-based GSP with artistic therapy was the most expensive scenario with a median per-patient-per-visit cost of $9.79 (8.83-10.7). An additional 3.54% (3.36-3.72) of 2023 county health budgets would be needed to increase mental health service coverage by 50% by 2030.
CONCLUSIONS: Integrating facility-based GSP within chronic disease care platforms offers a low-cost strategy for depression care provision. Reaching mental health service targets in Kenya may require 3% more of current health budgets.