Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial
Open accessAbstract
BACKGROUND: One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. METHODS: The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. RESULTS: Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. CONCLUSIONS: The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials. TRIAL REGISTRATION: clinicaltrials.gov Identifier: RPCGA-YRI-21003.
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Psychological therapy for young people in Sierra Leone who had experienced war-related psychological distress has a cost per quality-adjusted life-year gained equivalent to 2·6 times GDP per capita.
“For example, psychological therapy for young people in Sierra Leone who had experienced warrelated psychological distress has a cost per qualityadjusted life-year gained equivalent to 2·6 times GDP per capita. 447”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [447]
The Costs and cost-effectiveness section (page unavailable) reports an ICER of 2.6 times average GDP per capita, but only for participants in the upper quartile of symptom severity at baseline. The citing sentence omits that restriction and presents the figure as applying to the young people studied generally; the paper reports an overall ICER of $7,260 per QALY gained. (LLM, conf=0.93)
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Cites
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The Lancet Psychiatry Commission on youth mental health
McGorry, P. D., Mei, C., Dalal, N., Alvarez-Jimenez, M., Blakemore, S.-J., Browne, V., Dooley, B., Hickie, I. B., Jones, P. B., McDaid, D., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00163-9 · Cited by 663 · see citing works
- Authors
- McBain, R. K., Salhi, C., Hann, K., Salomon, J. A., Kim, J. J., & Betancourt, T. S.
- Affiliations
- Harvard University (US)
- Corresponding author
- McBain, Ryan K
- Venue
- Health Policy and Planning
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-09-07
- Volume
- 31
- Issue
- 4
- Pages
- 415-424
- ISSN
- 0268-1080 (ISSN-L)
- 1460-2237
- PMC
- PMC5007601
- OpenAlex
- W1828169963
- Cited by
- 28
- References
- 11
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 1 · 2016: 3
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Policy and Planning (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- United States Institute of Peace
- Harvard University
- Australian Psychological Society
- National Institutes of Health (5f31mh097333-02)
- Medical Research Council
- National Health and Medical Research Council
- National Institute on Aging (P30AG024409)
- National Institute of Mental Health (K01MH077246, 1F31MH097333-01A1)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
- Keywords
- cost-effectiveness, war-affected youth, psychological distress, functional disability, disability, school enrolment, school attendance, academic performance, mental health interventions, Sierra Leone, Freetown, sub-Saharan Africa, quality-adjusted life years, incremental cost-effectiveness ratio, intervention retention, economic costs, decision analysis
- MeSH terms
- Adolescent, Cost-Benefit Analysis, Female, Humans, Male, Mental Health Services, Psychotherapy, Group, Sierra Leone, Stress, Psychological, Warfare, Treatment Outcome, Health Care Costs, Young Adult
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