Costs and Cost-Effectiveness of Shamiri, a Brief, Layperson-Delivered Intervention for Kenyan Adolescents: a Randomized Controlled Trial
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Date
2023
Authors
Kacmarek, Corinne N.
Johnson, Natalie E.
Osborn, Tom L.
Wasanga, Christine
Weisz, John R.
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
Abstract
Background: Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental
health disorders, yet the fewest resources for prevention. Recently, many intervention strategies — including the
use of brief, scalable interventions— have emerged as ways of reducing the mental health treatment gap in
LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach
is through the evaluation of delivery costs alongside intervention effectiveness of various types of
interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group– and school–based intervention for
adolescent depression and anxiety that is delivered by lay-provider and that teaches growth mindset, gratitude,
and value affirmation.
Methods: We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation
Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were
estimated at treatment termination and 7-month follow-up using a standard definition and reliable and
clinically significant change definition of treatment benefit. Cost-effectiveness metrics included effectivenesscost ratios and cost per number needed to treat.
Results: Base case cost assumptions estimated that delivering Shamiri cost $15.17 (in 2021 U.S dollars) per
student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between
$48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically
significant change in depression and anxiety by 7-month follow-up.
Conclusions: Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in
depression and anxiety. Lay providers can deliver effective treatment for a fraction of the time that is required
to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic
perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and
anxiety after only 4 weekly sessions instead of the traditional 12-16 weekly sessions necessary for goldstandard cognitive behavioral therapy. The cost per “treated” student is acceptable relative to other schoolbased adolescent mental health interventions that have ranged from $52 to $56,500 per student with a
successful outcome.
Trial registration: This study was registered prior to participant enrollment in the Pan-African Clinical Trials
Registry (PACTR201906525818462), registered 20 Jun 2019, https://pactr.samrc.ac.za/Search.aspx.
Description
Article
Keywords
cost-effectiveness, global mental health, adolescents, lay provider, depression, anxiety, school-based, health promotion, low and middle income country
Citation
Kacmarek, C. N., Johnson, N. E., Osborn, T. L., Wasanga, C., Weisz, J. R., & Yates, B. T. (2023). Costs and cost-effectiveness of Shamiri, a brief, layperson-delivered intervention for Kenyan adolescents: A randomized controlled trial.