Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review

Abstract

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.

Economic evaluation of an online single-session intervention for depression in Kenyan adolescents.

“…A detailed description of the methods we used in our study (as well as other economic evaluation methods) can be found in Yates' (1996) manual. We also direct readers to Sung, Kacmarek, & Schleider (2021) for additional resources and recommendations for conducting economic evaluations for mental health interventions.…”

“…First, there is a great need for additional economic evaluations of interventions for youth. A recent systematic review found that there were only nine economic evaluations of youth mental health interventions, none of which were evaluations of digital interventions (Sung et al, 2021). Second, future research is needed to better understand for whom low-cost interventions are effective.…”

“…In fact, there have been few economic evaluations of youth mental health interventions in general. In a recent systematic review, Sung, Kacmarek, & Schleider (2021) identified only nine economic evaluations of youth mental health interventions, none of which were digital interventions. Two of the studies analyzed school-based interventions for adolescents, though neither of them targeted depression.…”

Cost-effectiveness analysis of paediatric mental health interventions: a systematic review of model-based economic evaluations

“…Mental disorders are projected to become the leading cause of mortality and morbidity by 2030 [ 6 ]. This growth is extremely problematic given that mental health disorders are the single largest contributing source of global economic burden [ 7 ]. This is evidenced by the global expenditure on treating depression and anxiety rising to US$ one trillion per year [ 2 ].…”

“…Although there is a wide variety of evidence-based strategies that have been implemented to combat this growing issue, a reduction in the level of economic burden placed upon health systems and resources is yet to be experienced. In fact, the most discernible implementation barrier for mental health interventions is their often resource-intensive nature [ 7 ]. Not only does this place increased strain on health resource allocations, but it also makes treatment far less accessible for lower income families, as the cost often incurs out of pocket expenses [ 8 , 9 ].…”