Cost-effectiveness of the mental health and development model for schizophrenia-spectrum and bipolar disorders in rural Kenya

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 eleven 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 two years. The cost per healthy day gained was Int$ 7.96 in the first year and Int$ 1.03 over two years – less than the agricultural minimum wage. The cost per DALY averted over two 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 two-years. Its affordability relies on multi-sectoral participation nationally and internationally.