title: Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Social Policy,London School of Economics and Political Science,UK.
authors.forename: V
authors.initials: V
authors.lastname: de Menil
authors.affiliation: Personal Social Services Research Unit,London School of Economics and Political Science,UK.
authors.forename: M
authors.initials: M
authors.lastname: Knapp
authors.affiliation: Personal Social Services Research Unit,London School of Economics and Political Science,UK.
authors.forename: D
authors.initials: D
authors.lastname: McDaid
authors.affiliation: Policy and Practice Directorate,BasicNeeds,India.
authors.forename: S
authors.initials: S
authors.lastname: Raja
authors.affiliation: BasicNeeds Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Kingori
authors.affiliation: BasicNeeds Kenya.
authors.forename: M
authors.initials: M
authors.lastname: Waruguru
authors.affiliation: Policy and Practice Directorate,BasicNeeds,India.
authors.forename: S K
authors.initials: SK
authors.lastname: Wood
authors.affiliation: Policy and Practice Directorate,BasicNeeds,India.
authors.forename: S
authors.initials: S
authors.lastname: Mannarath
authors.affiliation: Alan J. Flisher Centre for Public Mental Health,Department of Psychiatry and Mental Health,University of Cape Town,South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Lund
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007630:Kenya; D008297:Male; D008603:Mental Health / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012424:Rural Population; D012559:Schizophrenia / Q000453:epidemiology*
keywords: Africa; community mental health; economic outcomes; global mental health; severe mental disorders