Universal Mental Health Interventions for Children and Adolescents: A Systematic Review of Health Economic Evaluations
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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.
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.
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.
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.
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
MS and AW developed the search strategy and screened the studies for eligibility. MS extracted and synthesised data with input from AW and LA. MS drafted the manuscript, with input from AW, LA, SS, KP and NV. MS acts as the overall guarantor for the systematic review and accepts full responsibility for the conduct of the review and the decision to publish.
Compliance with Ethical Standards
Conflict of interest
Masja Schmidt, Amber Werbrouck, Nick Verhaeghe, Koen Putman, Steven Simoens and Lieven Annemans declare that they have no conflicts of interest relevant to this systematic review.
This study was funded by ‘Vlaams Agentschap voor Zorg en Gezondheid’ (VAZG, The Flemish Agency for Care and Health, grant number AZG/PREV/GE/2016-01). VAZG was involved in the selection of the topic but had no role in study selection, data collection, data synthesis or in writing the manuscript.
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