Cost and Budget Impact of Layering Depression Care Onto Existing HIV and Noncommunicable Disease Care Services in Western Kenya.

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.