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This is a RCT study (also classified as: Cross-Sectional Study, Quantitative Study).

October 10, 2025Open Access

Cost analysis of integrating depression treatment into chronic care in Malawi: evidence from a cluster randomised controlled trial

Key Points

Integrating depression care services into the Malawian health system is financially feasible.
The marginal cost of behavioral therapy was $90 per patient for five sessions, while antidepressant therapy cost $138 for eight sessions.
Human resources and consumables accounted for 45% and 30% of costs in behavioral therapy, respectively.
Over 15,000 screenings led to 398 adults receiving care, making a significant impact in the community.

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.

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