Discussion
anxiety
We aimed to identify the cost, effectiveness, and cost-effectiveness of Our economic evaluation is a rare contribution to the youth global mental health intervention literature and showcases how low-intensity interventions can have meaningful mental health impacts. With budgets for mental health decreasing and the need for prevention and treatment expected to increase, economic evaluations of mental health interventions are needed to guide mental health investment decisions. Sources of cost-savings included delivering the intervention in a group format at schools and training lay providers to deliver the intervention. Our results suggest that lay providers, after screening and training, can effectively deliver a mental health intervention. Of note, Purchasing power and cost of living differ between the U.S. and Kenya and contribute to differences in hourly wages and costs of goods/services. Relative to the U.S., it is between 52 to 71% less expensive to live in Kenya (Expatisan.com; Livingcost.org). This cost-of-living discrepancy between the U.S and Kenya is reflected in the different salaries for psychologists based in the U.S. versus Kenya: The U.S. psychologist was estimated to make $50/hour, whereas the psychologist in Kenya was estimated to make $3.67/hour. Additionally, the U.S. dollar goes much farther in Kenya than it does in the U.S. One could purchase $43.80 worth of goods/services in Kenya for every $1 spent in the U.S. for the same goods/services [Also of note, costs associated with transportation time alone for supervisors and lay providers accounted for nearly half (44.7%) of total costs in our base case scenario. Due to the rural geography of Kenya, supervisors and providers spent more time traveling to and from the school sites than they did delivering the intervention. When adding the out-of-pocket transit fees for both supervisors and lay providers, that proportion increased to 53.7% of base case delivery costs. Although total delivery costs for Another strength of our study was the 7-month time horizon. To put this time horizon in perspective, 16 of 42 (38%) of economic evaluations of anxiety treatment had a time horizon of less than 7 months [Categorical approaches, such as estimated incidence rates, can also illustrate the relationships between intervention costs and clinical outcomes. Although these approaches de-emphasize individual differences and, as a result, are less precise, some clinicians may find it useful to dichotomize treatment outcomes as a “success” or “failure.” We used multiple definitions of clinically significant change, which favored different conditions at different time points. For example, at treatment termination, students in the control condition fared better than students in We found that 