Universal Mental Health Interventions for Children and Adolescents: A Systematic Review of Health Economic Evaluations

Abstract

Background Effective mental health interventions may reduce the impact that mental health problems have on young people's well-being. Nevertheless, little is known about the cost effectiveness of such interventions for children and adolescents. Objectives The objectives of this systematic review were to summarize and assess recent health economic evaluations of universal mental health interventions for children and adolescents aged 6-18 years. Methods Four electronic databases were searched for relevant health economic studies, using a pre-developed search algorithm. Full health economic evaluations evaluating the cost effectiveness of universal mental health interventions were included, as well as evaluations of anti-bullying and suicide prevention interventions that used a universal approach. Studies on the prevention of substance abuse and those published before 2013 fell outside the scope of this review. Study results were summarised in evidence tables, and each study was subject to a systematic quality appraisal. Results Nine studies were included in the review; in six, the economic evaluation was conducted alongside a clinical trial. All studies except one were carried out in the European Union, and all but one evaluated school-based interventions. All evaluated interventions led to positive incremental costs compared to their comparators and most were associated with small increases in quality-adjusted life-years. Almost half of the studies evaluated the cost effectiveness of cognitive behavioural therapy-based interventions aimed at the prevention of depression or anxiety, with mixed results. Cost-effectiveness estimates for a parenting programme, a school-based social and emotional well-being programme and anti-bullying interventions were promising, though the latter were only evaluated for the Swedish context. Drivers of cost effectiveness were implementation costs; intervention effectiveness, delivery mode and duration; baseline prevalence; and the perspective of the evaluation. The overall study quality was reasonable, though most studies only assessed short-term costs and effects. Conclusion Few studies were found, which limits the possibility of drawing strong conclusions about cost effectiveness. There is some evidence based on decision-analytic modelling that anti-bullying interventions represent value for money. Generally, there is a lack of studies that take into account long-term costs and effects. Systematic Review Registration Number CRD42019115882.Steven Simoens and Lieven Annemans share last authorship.

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“…Cost-effectiveness analysis (CEA) has been widely used to support health technology assessment decision-making process [1][2][3]. The main result of CEA is called the incremental costeffectiveness ratio (ICER) which means the cost-effectiveness of a health intervention when compared to another [4,5]. In this ratio, the difference between total costs of two interventions represents the ratio numerator and the difference between total effectiveness of these treatments represents the ratio denominator.…”

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“…Several articles focused on efforts to improve mental health care for vulnerable populations [15][16][17][18]. Cullinan et al examined socioeconomic disparities in unmet need for student mental health services in higher education in Ireland [15].…”

“…Schmidt et al conducted a systematic review of health economic evaluations of universal mental health Interventions for children and adolescents [17]. Only nine studies were included in the review, with considerable variation between studies regarding intervention aims, methodology and outcome measures, thereby limiting the generalizability of findings.…”

“…Only nine studies were included in the review, with considerable variation between studies regarding intervention aims, methodology and outcome measures, thereby limiting the generalizability of findings. The authors note that there is some evidence based on decision-analytic modelling that anti-bullying interventions represent value for money but further research is warranted [17].…”