Objective: To evaluate the costs and cost-effectiveness of Shamiri-Digital, an online single-session intervention (SSI) for depression among Kenyan adolescents.Method: Data were drawn from a randomized clinical trial with n=103 Kenyan high school students (64% female, Mage=15.5). All students were eligible to participate, regardless of baseline depression symptomatology. We estimated delivery costs in 2020 US dollars from multiple perspectives. To account for uncertainty, we performed sensitivity analyses with different cost assumptions and definitions of effectiveness. Using number needed to treat (NNT) estimates, we also evaluated the cost required to achieve a clinically meaningful reduction in depressive symptoms.Results: In the base-case (the most realistic cost estimate), it cost US $3.57 per student to deliver Shamiri-Digital. Depending on the definition of clinically meaningful improvement, 7.1 to 9.7 students needed to receive the intervention for one student to experience a clinically meaningful improvement, which translated to a cost of US $25.35 to US $34.62 per student.Under a worst-case scenario (i.e., assuming the highest treatment cost and the strictest effectiveness definition), the cost to achieve clinically meaningful improvement was US $92.05 per student.Conclusions: Shamiri-Digital is a low-cost intervention for reducing depression symptomatology. The public health benefit of empirically supported SSIs is especially important in low-income countries, where funding for mental health care is most limited. Future research can compare the cost-effectiveness of online SSIs to higher-cost treatments and estimate the robustness of Shamiri-Digital's effects over a longer time horizon.

The United States (US) spent 201 billion dollars on mental health related concerns in 2016, ranking mental illness as the leading cause of disability and the single largest source of economic burden worldwide. With mental health related treatment costs and economic burden only projected to rise, there is an increasing need for cost-inclusive evaluations of mental health interventions in the US. This systematic review evaluated the intervention characteristics and the quality of 9 economic evaluation studies (e.g., cost-effectiveness, cost-benefit) of youth mental health services conducted in the US from 2003 to 2019. Existing evaluations suggest that certain mental health interventions for youth, among the few that have been formally evaluated, may be cost-effective and cost-beneficial. However, intervention characteristics were generally homogenous, a majority of studies did not adhere to the standard of economic evaluations of the CHEERS checklist, and outcome measures were not consistently clinically useful; limiting the utility of such youth mental health economic evaluations to policymakers. By adhering to standards of economic evaluations and diversifying the characteristics of interventions subject to economic evaluations, intervention researchers can increase confidence in conclusions about which youth mental health interventions are cost-effective or cost-beneficial and more meaningfully inform evidence-based mental health policy.

BACKGROUND There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. One key factor in this debate involves the extent to which racial and ethnic minoritized and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. OBJECTIVE We examined racial and ethnic as well as socioeconomic differences in participants’ willingness-to-pay (WTP) for DMHIs vs. face-to-face (F2F) therapy. METHODS We conducted a nationally representative survey of people in the United States (N = 423, women: n = 203, age: M = 45.36, SD = 16.25, Non-Hispanic White: n = 291) via Prolific. After reading descriptions of DMHIs and F2F-therapy, participants rated their willingness-to-try each treatment for 1) free, 2) for a small fee, 3) for a large fee (for F2F-therapy only), 4) as a maximum dollar amount, and 5) as a percentage of their total monthly income. At the end of the study there was a decision task to potentially receive more information about DMHIs and F2F-therapyWe conducted a nationally representative survey of people in the United States (N = 423, women: n = 203, age: M = 45.36, SD = 16.25, Non-Hispanic White: n = 291) via Prolific. After reading descriptions of DMHIs and F2F-therapy, participants rated their willingness-to-try each treatment for 1) free, 2) for a small fee, 3) for a large fee (for F2F-therapy only), 4) as a maximum dollar amount, and 5) as a percentage of their total monthly income. At the end of the study there was a decision task to potentially receive more information about DMHIs and F2F-therapy. RESULTS Race and ethnicity were associated with willingness to pay higher amounts of one’s income, as a percent or the dollars, and was also associated with information-seeking for DMHIs in the behavioral task. By and large, race and ethnicity was not associated with willingness to try F2F-therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for F2F therapy. Income was inconsistently associated to willingness to try DMHIs and F2F-therapy. CONCLUSIONS DMHIs may reduce inequities by expanding access to mental healthcare for racial and ethnic minoritized individuals and economically disadvantaged groups, especially if they are available for free or at very low costs. CLINICALTRIAL N/A

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 effectiveness-cost 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 gold-standard cognitive behavioral therapy. The cost per “treated” student is acceptable relative to other school-based 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.

Background Computer‐based delivery of cognitive behavioral therapy (CBT) may be a less costly approach to increase dissemination and implementation of evidence‐based treatments for alcohol use disorder (AUD). However, comprehensive evaluations of costs, cost‐effectiveness, and cost–benefit of computer‐delivered interventions are rare. Methods This study used data from a completed randomized clinical trial to evaluate the cost‐effectiveness and cost–benefit of a computer‐based version of CBT (CBT4CBT) for AUD. Sixty‐three participants were randomized to receive one of the following treatments at an outpatient treatment facility and attended at least one session: (1) treatment as usual (TAU), (2) CBT4CBT plus treatment as usual (CBT4CBT+TAU), or (3) CBT4CBT plus brief monitoring. Results Median protocol treatment costs per participant differed significantly between conditions, Kruskal‐Wallis H(2) = 8.40, p = 0.02, such that CBT4CBT+TAU and CBT4CBT+monitoring each cost significantly more per participant than TAU. However, when nonprotocol treatment costs were included, total treatment costs per participant did not differ significantly between conditions. Median incremental cost‐effective ratios (ICERs) revealed that CBT4CBT+TAU was more costly and more effective than TAU. It cost $35.08 to add CBT4CBT to TAU to produce a reduction of one additional drinking day per month between baseline and the end of the 8‐week treatment protocol: CBT4CBT+monitoring cost $33.70 less to produce a reduction of one additional drinking day per month because CBT4CBT+monitoring was less costly than TAU and more effective at treatment termination, though not significantly so. Net benefit analyses suggested that costs of treatment, regardless of condition, did not offset monthly costs related to healthcare utilization, criminal justice involvement, and employment disruption between baseline and 6‐month follow‐up. Benefit–cost ratios were similar for each condition. Conclusions Results of this pilot economic evaluation suggest that an 8‐week course of CBT4CBT may be a cost‐effective addition and potential alternative to standard outpatient treatment for AUD. Additional research is needed to generate conclusions about the cost–benefit of providing CBT4CBT to treatment‐seeking individuals participating in standard outpatient treatment.