Attachments
Executive Summary
In 2022–2023, the International Rescue Committee (IRC) integrated a mental health counseling intervention called the Common Elements Treatment Approach (CETA) into routine chronic disease care, which included medical care for hypertension (HT), diabetes (DM) and mental health disorders among adult refugees in Mae La Refugee Camp in Thailand. The IRC, Khon Kaen University (KKU), and Johns Hopkins University (JHU) conducted a randomized controlled trial (RCT) and cost-effectiveness analysis to understand if a treatment group who received the CETA intervention on top of routine chronic disease care would experience any changes in medication adherence, health behaviors (unhealthy dietary intake and substance use), and clinical outcomes, and at what cost, compared to a waitlist control group who received routine chronic disease care.
Excluding start-up costs, the ongoing implementation for routine chronic disease care cost about $549 per patient per year (including program, support, and indirect costs). Adding the CETA intervention cost an additional 29% ($157 per patient per year), for a total of $706 per patient per year. One limitation of the study is a margin of error of about 20% across all costs.
CETA integrated in routine chronic disease care showed statistically significant effects in improving medication adherence, reducing mental health symptoms, and improving selfefficacy, but not in improving clinical outcomes. Integrating CETA in routine chronic disease care could potentially be cost-effective in improving mental health, if there are no alternative interventions that can achieve better or comparable outcomes at similar or lower cost per patient per year for this population. More research on the impacts and costs of interventions to improve mental health and clinical outcomes for adult refugees living with NCDs and mental health disorders in humanitarian settings is needed.