Attributes of care that may improve cost-effectiveness in youth mental health service systems

Matthew P Hamilton, Sarah E Hetrick, Cathrine Mihalopoulos, David Baker, Vivienne Browne, Andrew M Chanen, Kerryn Pennell, Rosemary Purcell, Heather Stavely and Patrick D McGorry


Objective: To identify attributes of youth mental health care for which there is evidence of potential cost-effectiveness.

Study design: We performed a literature review of economic evaluations that examined both costs and outcomes for attributes of youth mental health care other than pharmacological or individual psychological therapies for full-threshold disorders.

Data sources: We searched the United Kingdom National Health Service Economic Evaluations Database for evaluations published to the end of 2014; and MEDLINE, Google Scholar and the citation lists of relevant publications for peer-reviewed studies published in English since 1997.

Data synthesis: Forty economic evaluations met inclusion criteria. Psychosis was the mental disorder with the most developed economic evidence base, with good evidence of cost-effectiveness for first-episode psychosis services. There was a developing cost-effectiveness evidence base for other disorders. The most common attributes of the interventions examined in the included studies were the location of services, engagement and support of families, assessment, prevention, early intervention, group delivery format and information provision. We used our findings to formulate a list of attributes of youth mental health care that may be acceptable to young people and potentially cost-effective.

Conclusion: There is at least suggestive cost-effectiveness evidence for a range of attributes of youth mental health care. Further economic research is needed to substantiate most cost-effectiveness findings and to improve targeting of care among young people. Future economic evaluations should examine costs from both societal and health care perspectives and incorporate evidence regarding young people’s preferences.

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