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. 2023 Mar 17;23(1):178.
doi: 10.1186/s12888-023-04665-4.

Cost-utility analysis of the UPRIGHT intervention promoting resilience in adolescents

Javier Mar  1   2   3 , Igor Larrañaga  4   5 , Oliver Ibarrondo  4   6 , Ana González-Pinto  7   8   9   10 , Carlota Las Hayas  5   11 , Ane Fullaondo  5 , Irantzu Izco-Basurko  5 , Jordi Alonso  11   12   13 , Iñaki Zorrilla  8   9   10   14 , Jessica Fernández-Sevillano  9   10   14 , Esteban de Manuel  5 ; UPRIGHT Consortium
Collaborators, Affiliations

Cost-utility analysis of the UPRIGHT intervention promoting resilience in adolescents

Javier Mar et al. BMC Psychiatry. .

Abstract

Background: As mental health in adulthood is related to mental status during adolescence, school-based interventions have been proposed to improve resilience. The objective of this study was to build a simulation model representing the natural history of mental disorders in childhood, adolescence and youth to estimate the cost-effectiveness of the UPRIGHT school-based intervention in promoting resilience and mental health in adolescence.

Methods: We built a discrete event simulation model fed with real-world data (cumulative incidence disaggregated into eight clusters) from the Basque Health Service database (609,381 individuals) to calculate utilities (quality-adjusted life years [QALYs]) and costs for the general population in two scenarios (base case and intervention). The model translated changes in the wellbeing of adolescents into different risks of mental illnesses for a time horizon of 30 years.

Results: The number of cases of anxiety was estimated to fall by 5,125 or 9,592 and those of depression by 1,269 and 2,165 if the effect of the intervention lasted 2 or 5 years respectively. From a healthcare system perspective, the intervention was cost-effective for all cases considered with incremental cost-utility ratios always lower than €10,000/QALY and dominant for some subgroups. The intervention was always dominant when including indirect and non-medical costs (societal perspective).

Conclusions: Although the primary analysis of the trial did not did not detect significant differences, the UPRIGHT intervention promoting positive mental health was dominant in the economic evaluation from the societal perspective. Promoting resilience was more cost-effective in the most deprived group. Despite a lack of information about the spillover effect in some sectors, the economic evaluation framework developed principally for pharmacoeconomics can be applied to interventions to promote resilience in adolescents. As prevention of mental health disorders is even more necessary in the post-coronavirus disease-19 era, such evaluation is essential to assess whether investment in mental health promotion would be good value for money by avoiding costs for healthcare providers and other stakeholders.

Keywords: Adolescents health; Health policy; Mental disorders; Mental health; Prevention; Resilience; Simulation model.

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Conflict of interest statement

The authors have no biomedical financial interests or potential conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Theoretical representation of the natural history of mental disorders according to the level of psychological resilience in two scenarios of risk (general population and UPRIGHT population)
Fig. 2
Fig. 2
Three examples of assignment of time until the onset of mental disorders, based on the cumulative incidence (empirical distribution) and random numbers
See this image and copyright information in PMC

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