{
  "abstract": "Objective To quantify the costs associated with a stepped model of depression care—Integrated Chronic Care Clinics-Depression Module (IC3D)—in rural Malawi.Design Cross-sectional cost analysis.Setting Integrated chronic care clinics (n=14) throughout Neno District, Malawi.Interventions The stepped model of depression care provided behavioural therapy (Problem Management Plus (PM+)) to adults (aged 18+) with moderate depression and joint PM+ and antidepressant therapy (ADT) to those with moderate-to-severe and severe depression. The model incorporated two cost-saving features: treatment was integrated into existing chronic care services within the health system, and PM+ was group-based rather than one-on-one.Primary and secondary outcome measures We conducted time-driven activity-based costing to quantify the marginal economic cost of implementing PM+ and ADT, inclusive of training and supervision. We measured all costs in 2025 US dollars and quantified costs from a societal perspective—including human resources, infrastructure, equipment, consumables, indirect costs and opportunity costs.Results The marginal cost of PM+ was $90 per patient treated for five sessions over 2 months, while ADT was $138 for eight sessions over 8 months. In both instances, human resources (45% from PM+, 52% for ADT) and consumables (30% for PM+, 31% for ADT) represented primary health system cost drivers. In the first year of implementation, 15 002 depression screenings were conducted, 724 adults were evaluated with a diagnostic tool and 398 adults subsequently received care: 263 received PM+ alone, 31 received ADT alone and 104 received both PM+ and ADT. The total cost of introducing operations throughout Neno District was $62 806.Conclusions These findings indicate that integrating depression care services into the Malawian health system is financially feasible and successfully reached many individuals with major depressive disorder.Trial registration number NCT04777006.",
  "authors": [
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Owen Mwale"
    },
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Kondwani Mpinga"
    },
    {
      "affiliations": [
        "Pardee RAND Graduate School, Santa Monica, California, USA"
      ],
      "name": "Temusa Rukundo"
    },
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Myrrah Kamwiyo"
    },
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Waste Kayira"
    },
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Beatrice Matanje"
    },
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Fabien Munyaneza"
    },
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Todd Ruderman"
    },
    {
      "affiliations": [
        "Partners In Health, Boston, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Giuseppe Raviola"
    },
    {
      "affiliations": [
        "Partners In Health, Boston, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Stephanie Smith"
    },
    {
      "affiliations": [
        "RAND Corporation, Arlington, Virginia, USA"
      ],
      "name": "Adeyemi Okunogbe"
    },
    {
      "affiliations": [
        "Partners In Health, Neno, Malawi"
      ],
      "name": "Chiyembekezo Kachimanga"
    },
    {
      "affiliations": [
        "RAND Corporation, Arlington, Virginia, USA"
      ],
      "name": "Ryan K McBain"
    }
  ],
  "title": "Cost analysis of integrating depression treatment into chronic care in Malawi: evidence from a cluster randomised controlled trial",
  "uid": "ea8c8de0-f295-5b5e-867f-a2f78f34c846"
}