Skip to main content

Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review

Clinical Child and Family Psychology Review volume 24, pages 1–19 (2021)Cite this article

Abstract

The United States (US) spent 201 billion dollars on mental health-related concerns in 2016, ranking mental illness as the leading cause of disability and the single largest source of economic burden worldwide. With mental health-related treatment costs and economic burden only projected to rise, there is an increasing need for cost-inclusive evaluations of mental health interventions in the US. This systematic review evaluated the intervention characteristics and the quality of 9 economic evaluation studies (e.g., cost-effectiveness, cost–benefit) of youth mental health services conducted in the US from 2003 to 2019. Existing evaluations suggest that certain mental health interventions for youth, among the few that have been formally evaluated, may be cost-effective and cost-beneficial. However, intervention characteristics were generally homogenous, a majority of studies did not adhere to the standard of economic evaluations of the CHEERS checklist, and outcome measures were not consistently clinically useful, limiting the utility of such youth mental health economic evaluations to policymakers. By adhering to standards of economic evaluations and diversifying the characteristics of interventions subject to economic evaluations, intervention researchers can increase confidence in conclusions about which youth mental health interventions are cost-effective or cost-beneficial and more meaningfully inform evidence-based mental health policy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

Notes

  1. We estimated the cost/youth by dividing total intervention costs ($46,803 in 2008 USD) by the number of youth served (254) in Wang et al. (2011) study. Dickerson et al. (2018) reported both adjusted and unadjusted per youth means; we used their adjusted means in our mean and median cost/youth calculations.

  2. An average CER can be considered an ICER when the costs and effectiveness of a comparator are each expected to be 0.

References

  • Aarons, G. A., Wells, R. S., Zagursky, K., Fettes, D. L., & Palinkas, L. A. (2009). Implementing evidence-based practice in community mental health agencies: A multiple stakeholder analysis. American Journal of Public Health, 99(11), 2087–2095.

    PubMed  PubMed Central  Google Scholar 

  • Bala, M. V., & Zarkin, G. A. (2002). Application of cost-effectiveness analysis to multiple products: A practical guide. The American Journal of Managed Care, 8(3), 211–218.

    PubMed  Google Scholar 

  • Basu, A. (2016). Estimating costs and valuations of non-health benefits in cost-effectiveness analysis. In P. J. Neumann (Ed.), Cost-effectiveness in health and medicine (pp. 201–236). Oxford: Oxford University Press.

    Google Scholar 

  • Baumgardner, J. R., & Neumann, P. J. (2017). Balancing the use of cost-effectiveness analysis across all types of health care innovations. Health Affairs Blog. https://doi.org/10.1377/hblog20170414.059610.

    Article  Google Scholar 

  • Bennett, S. D., Cuijpers, P., Ebert, D. D., McKenzie Smith, M., Coughtrey, A. E., Heyman, I., et al. (2019). Practitioner review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 60(8), 828–847.

    PubMed  Google Scholar 

  • Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L. R., Fathima, S., et al. (2011). The global economic burden of non communicable diseases. Geneva: World Economic Forum.

    Google Scholar 

  • Bogenschneider, K., & Corbett, T. J. (2010). Evidence-based policymaking: Insights from policy-minded researchers and research-minded policymakers. New York: Taylor & Francis.

    Google Scholar 

  • Bond, G. R., Drake, R. E., McHugo, G. J., Peterson, A. E., Jones, A. M., & Williams, J. (2014). Long-term sustainability of evidence-based practices in community mental health agencies. Administration and Policy in Mental Health, 41(2), 228–236.

    PubMed  Google Scholar 

  • Buchanan, D., Fitzgerald, L., Ketley, D., Gollop, R., Jones, J. L., Lamont, S. S., et al. (2005). No going back: A review of the literature on sustaining organizational change. International Journal of Management Reviews, 7(3), 189–205. https://doi.org/10.1111/j.1468-2370.2005.00111.x.

    Article  Google Scholar 

  • Cidav, Z., Mandell, D., Pyne, J., Beidas, R., Curran, G., & Marcus, S. (2020). A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implementation Science: IS, 15(1), 28.

    PubMed  Google Scholar 

  • Cohen, J., Malins, A., & Shahpurwala, Z. (2013). Compared to US practice, evidence-based reviews in Europe appear to lead to lower prices for some drugs. Health Affairs, 32(4), 762–770.

    PubMed  Google Scholar 

  • Crowley, D. M., Dodge, K. A., Barnett, W. S., Corso, P., Duffy, S., Graham, P., et al. (2018). Standards of evidence for conducting and reporting economic evaluations in prevention science. Prevention Science: The Official Journal of the Society for Prevention Research, 19(3), 366–390.

    Google Scholar 

  • Dickerson, J. F., Lynch, F. L., Leo, M. C., DeBar, L. L., Pearson, J., & Clarke, G. N. (2018). Cost-effectiveness of cognitive behavioral therapy for depressed youth declining antidepressants. Pediatrics, 141(2), 1969. https://doi.org/10.1542/peds.2017-1969.

    Article  Google Scholar 

  • Dino, G., Horn, K., Abdulkadri, A., Kalsekar, I., & Branstetter, S. (2008). Cost-effectiveness analysis of the not on tobacco program for adolescent smoking cessation. Prevention Science, 9(1), 38–46. https://doi.org/10.1007/s11121-008-0082-0.

    Article  PubMed  Google Scholar 

  • Dopp, A. R., Schaeffer, C. M., Swenson, C. C., & Powell, J. S. (2018). Economic impact of multisystemic therapy for child abuse and neglect. Administration and Policy in Mental Health, 45(6), 876–887.

    PubMed  PubMed Central  Google Scholar 

  • Duncan, K. M., MacGillivray, S., & Renfrew, M. J. (2017). Costs and savings of parenting interventions: Results of a systematic review. Child: Care, Health and Development, 43(6), 797–811. https://doi.org/10.1111/cch.12473.

    Article  Google Scholar 

  • Eells, T. D. (1999). Is there a cost offset to psychotherapy? The Journal of Psychotherapy Practice and Research, 8(3), 243–247.

    PubMed  PubMed Central  Google Scholar 

  • Elliott, K., Barker, K. K., & Hunsley, J. (2015). Dodo bird verdict in psychotherapy. The Encyclopedia of Clinical Psychology. https://doi.org/10.1002/9781118625392.wbecp053.

    Article  Google Scholar 

  • Evers, S. M. A., Van Wijk, A. S., & Ament, A. J. H. (1997). Economic evaluation of mental health care interventions: A review. Health Economics, 6(2), 161–177.

    PubMed  Google Scholar 

  • Evers, S., Salvador-Carulla, L., Halsteinli, V., McDaid, D., & Mheen Group. (2007). Implementing mental health economic evaluation evidence: Building a bridge between theory and practice. Journal of Mental Health, 16(2), 223–241.

    Google Scholar 

  • Firth, J., Torous, J., Nicholas, J., Carney, R., Pratap, A., Rosenbaum, S., & Sarris, J. (2017). The efficacy of smartphone-based mental health interventions for depressive symptoms: A meta-analysis of randomized controlled trials. World Psychiatry: Official Journal of the World Psychiatric Association, 16(3), 287–298.

    Google Scholar 

  • Firth, J., Torous, J., Nicholas, J., Carney, R., Rosenbaum, S., & Sarris, J. (2017). Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 218, 15–22.

    PubMed  Google Scholar 

  • Foster, E. M., Olchowski, A. E., & Webster-Stratton, C. H. (2007). Is stacking intervention components cost-effective? An analysis of the incredible years program. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1414–1424.

    PubMed  Google Scholar 

  • French, A. N., Yates, B. T., & Fowles, T. R. (2018). Cost-effectiveness of parent–child interaction therapy in clinics versus homes: Client, provider, administrator, and overall perspectives. Journal of Child and Family Studies, 27(10), 3329–3344. https://doi.org/10.1007/s10826-018-1159-4.

    Article  Google Scholar 

  • González, M. J. (2005). Access to mental health services: The struggle of poverty affected urban children of color. Child Adolescent Social Work Journal, 22, 245–256. https://doi.org/10.1007/BF02679471.

    Article  Google Scholar 

  • Hoagwood, K. E., Atkins, M., Kelleher, K., Peth-Pierce, R., Olin, S., Burns, B., Landsverk, J., & Horwitz, S. M. (2018). Trends in children’s mental health services research funding by the national institute of mental health from 2005 to 2015: A 42% reduction. Journal of the American Academy of Child & Adolescent Psychiatry, 57(1), 10–13. https://doi.org/10.1016/j.jaac.2017.09.433.

  • Hoch, J. S., & Dewa, C. S. (2008). A clinician’s guide to correct cost-effectiveness analysis: Think incremental not average. Canadian Journal of Psychiatry, 53(4), 267–274. https://doi.org/10.1177/070674370805300408.

    Article  PubMed  Google Scholar 

  • Hodgins, S., Cree, A., Alderton, J., & Mak, T. (2008). From conduct disorder to severe mental illness: Associations with aggressive behaviour, crime and victimization. Psychological Medicine, 38(7), 975–987.

    PubMed  Google Scholar 

  • Honeycutt, A.A., Clayton, L., Khavjou, O., Finkelstein, E.A., Prabhu, M., Blitstein, J.L., Evans, W.D., Renaud, J.M (2006). Guide to analyzing the cost-effectiveness of community public health prevention approaches. Office of the Assistant Secretary for Planning and Evaluation, US, Department of Health and Human Services, Washington, DC. https://aspe.hhs.gov/system/files/pdf/74686/report.pdf

  • Honeycutt, A. A., Clayton, L., Khavjou, O., Finkelstein, E. A., Prabhu, M., Blitstein, J. L., Renaud, J. M., et al. (2006). Guide to analyzing the cost-effectiveness of community public health prevention approaches. RTI Project Number 0208827.001, (0208827)

  • Honeycutt, A. A., Khavjou, O. A., Jones, D. J., Cuellar, J., & Forehand, R. L. (2015). Helping the noncompliant child: An assessment of program costs and cost-effectiveness. Journal of Child and Family Studies, 24(2), 499–504.

    PubMed  Google Scholar 

  • Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., et al. (2013). Consolidated Health economic evaluation reporting standards (CHEERS) statement. International Journal of Technology Assessment in Health Care, 29(2), 117–122.

    PubMed  Google Scholar 

  • Jain, R., Grabner, M., & Onukwugha, E. (2011). Sensitivity analysis in cost-effectiveness studies: From guidelines to practice. PharmacoEconomics, 29(4), 297–314.

    PubMed  Google Scholar 

  • Jones, P. B. (2013). Adult mental health disorders and their age at onset. British Journal of Psychiatry, 202(s54), s5–s10. https://doi.org/10.1192/bjp.bp.112.119164.

    Article  Google Scholar 

  • Kaplan, R. M., Gold, M., Duffy, S. Q., Miller, N., Glassman, J. R., Chambers, D. A., et al. (2019). Economic analysis in behavioral health: Toward application of standardized methodologies. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 38(8), 672–679.

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602.

    PubMed  Google Scholar 

  • Kilian, R., Losert, C., Park, A.-L., McDaid, D., & Knapp, M. (2010). Cost-effectiveness analysis in child and adolescent mental health problems: An updated review of literature. The International Journal of Mental Health Promotion, 12(4), 45–57.

    Google Scholar 

  • Lattie, E. G., Adkins, E. C., Winquist, N., Stiles-Shields, C., Wafford, Q. E., & Graham, A. K. (2019). Digital mental health interventions for depression, anxiety, and enhancement of psychological well-being among college students: Systematic review. Journal of Medical Internet Research, 21(7), e12869.

    PubMed  PubMed Central  Google Scholar 

  • Leibson, C. L., & Long, K. H. (2003). Economic implications of attention-deficit hyperactivity disorder for healthcare systems. PharmacoEconomics, 21(17), 1239–1262.

    PubMed  Google Scholar 

  • Neumann, P. J. (2009). Costing and perspective in published cost-effectiveness analysis. Medical Care, 7(1), 28–32.

    Google Scholar 

  • Neumann, P. J., Cohen, J. T., & Weinstein, M. C. (2014). Updating cost-effectiveness–the curious resilience of the $50,000-per-QALY threshold. The New England Journal of Medicine, 371(9), 796–797.

    PubMed  Google Scholar 

  • Neumann, P. J., Sanders, G. D., Russell, L. B., Ganiats, T. G., & Siegel, J. E. (2017). Cost-effectiveness in health and medicine. Oxford: Oxford University Press.

    Google Scholar 

  • Ocasio, K., Van Alst, D., Koivunen, J., Huang, C.-C., & Allegra, C. (2015). Promoting preschool mental health: Results of a 3 year primary prevention strategy. Journal of Child and Family Studies, 24(6), 1800–1808. https://doi.org/10.1007/s10826-014-9983-7.

    Article  Google Scholar 

  • Purtle, J., Dodson, E. A., Nelson, K., Meisel, Z. F., & Brownson, R. C. (2018). Legislators’ sources of behavioral health research and preferences for dissemination: Variations by political party. Psychiatric Services, 69(10), 1105–1108.

    PubMed  Google Scholar 

  • Purtle, J., Nelson, K. L., Bruns, E. J., & Hoagwood, K. E. (2020). Dissemination strategies to accelerate the policy impact of children’s mental health services research. Psychiatric Services in Advance. https://doi.org/10.1176/appi.ps.201900527.

    Article  Google Scholar 

  • Ravens-Sieberer, U., Karow, A., Barthel, D., & Klasen, F. (2014). How to assess quality of life in child and adolescent psychiatry. Dialogues in Clinical Neuroscience, 16(2), 147–158.

    PubMed  PubMed Central  Google Scholar 

  • Roehrig, C. (2016). Mental disorders top the list of the most costly conditions in the United States: $201 Billion. Health Affairs, 35(6), 1130–1135.

    PubMed  Google Scholar 

  • Romeo, R., Byford, S., & Knapp, M. (2005). Annotation: Economic evaluations of child and adolescent mental health interventions: A systematic review. Journal of Child Psychology and Psychiatry, 46(9), 919–930. https://doi.org/10.1111/j.1469-7610.2005.00407.x.

    Article  PubMed  Google Scholar 

  • Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6(3), 412–415. https://doi.org/10.1111/j.1939-0025.1936.tb05248.x.

    Article  Google Scholar 

  • Roundfield, K. D., & Lang, J. M. (2017). Costs to community mental health agencies to sustain an evidence-based practice. Psychiatric Services, 68(9), 876–882.

    PubMed  Google Scholar 

  • Sava, F. A., Yates, B. T., Lupu, V., Szentagotai, A., & David, D. (2009). Cost-effectiveness and cost-utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (Prozac) in treating depression: A randomized clinical trial. Journal of Clinical Psychology, 65(1), 36–52.

  • Saxena, S., Lora, A., Van Ommeren, M., Barrett, T., Morris, J., & Saraceno, B. (2007). WHO’s Assessment instrument for mental health systems: Collecting essential information for policy and service delivery. Psychiatric Services, 58(6), 816–821.

    PubMed  Google Scholar 

  • Schleider, J. L., & Weisz, J. R. (2017). Little treatments, promising effects? Meta-analysis of single-session interventions for youth psychiatric problems. Journal of the American Academy of Child and Adolescent Psychiatry, 56(2), 107–115.

    PubMed  Google Scholar 

  • Shearer, J., McCrone, P., & Romeo, R. (2016). Economic evaluation of mental health interventions: A guide to costing approaches. PharmacoEconomics, 34(7), 651–664. https://doi.org/10.1007/s40273-016-0390-3.

    Article  PubMed  Google Scholar 

  • Stoll, R. D., Pina, A. A., & Schleider, J. (2020). Brief, non-pharmacological, interventions for pediatric anxiety: Meta-analysis and evidence base status. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division, 53, 1–27.

    Google Scholar 

  • Substance Abuse and Mental Health Services Administration (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-48, HHS Publication No. SMA 14–4863). Rockville, MD: Substance Abuse and Mental Health Services Administration.

  • Tran, J. L. A., Sheng, R., Beaulieu, A., Villodas, M., McBurnett, K., Pfiffner, L. J., & Wilson, L. (2018). Cost-effectiveness of a behavioral psychosocial treatment integrated across home and school for pediatric ADHD-inattentive type. Administration and Policy in Mental Health, 45(5), 741–750.

    PubMed  Google Scholar 

  • U.S. Public Health Service. (2000). Report of the surgeon general’s conference on children’s mental health: A national action Agenda. Washington, D.C

  • Wang, L. Y. (2011). The economic effect of planet health on preventing Bulimia Nervosa. Archives of Pediatrics & Adolescent Medicine, 165(8), 756. https://doi.org/10.1001/archpediatrics.2011.105.

    Article  Google Scholar 

  • Washington State Institute for Public Policy. (2019). Benefit-cost technical documentation. Olympia, WA: WSIPP.

    Google Scholar 

  • Weiss, C. H. (1979). The many meanings of research utilization. Public Administration Review, 39(5), 426. https://doi.org/10.2307/3109916.

    Article  Google Scholar 

  • Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013). Performance of evidence-based youth psychotherapies compared with usual clinical care: A multilevel meta-analysis. JAMA Psychiatry., 70(7), 750–761. https://doi.org/10.1001/jamapsychiatry.2013.1176.

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., et al. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. The American Psychologist, 72(2), 79–117.

    PubMed  Google Scholar 

  • Wellander, L., Wells, M. B., & Feldman, I. (2016). Does prevention pay? Costs and potential cost-savings of school interventions targeting children with mental health problems. The Journal of Mental Health Policy and Economics, 19(2), 91–101.

    PubMed  Google Scholar 

  • Whitehead, S. J., & Ali, S. (2010). Health outcomes in economic evaluation: The QALY and utilities. British Medical Bulletin, 96(1), 5–21. https://doi.org/10.1093/bmb/ldq033.

  • Williams, C., Lewsey, J. D., Briggs, A. H., & Mackay, D. F. (2017). Cost-effectiveness analysis in R using a multi-state modeling survival analysis framework: A tutorial. Medical Decision Making, 37(4), 340–352. https://doi.org/10.1177/0272989x16651869.

    Article  PubMed  Google Scholar 

  • Witters, D., Liu, D., & Agrawal, S. (2013). Depression costs US workplaces $23 billion in absenteeism. Gallup Well-Being, Washington, DC. Available at: https://news.gallup.com/poll/163619/depression-costs-workplaces-billionabsenteeism.aspx.

  • World Health Organization. (2011). Global status report on noncommunicable diseases 2010.

  • Yates, B. T. (1985). Cost-effectiveness analysis and cost-benefit analysis: An introduction. Behavioral Assessment, 7(3), 207–234.

  • Yates, B. T. (1996). Analyzing costs, procedures, processes, and outcomes in human services: An introduction. Thousand Oaks: SAGE.

    Google Scholar 

  • Yates, B. T. (2018). Commentary on “standards of evidence for conducting and reporting economic evaluations in prevention science” [Review of commentary on “Standards of evidence for conducting and reporting economic evaluations in prevention science”]. Prevention Science: The Official Journal of the Society for Prevention Research, 19(3), 396–401.

    Google Scholar 

  • Yates, B. T. (2020). Research on improving outcomes and reducing costs of psychological interventions: Toward delivering the best to the most for the least. Annual Review of Clinical Psychology, 16, 125–150.

    PubMed  Google Scholar 

  • Zechmeister, I., Kilian, R., McDaid, D., & MHEEN group. (2008). Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations. BMC Public Health, 8, 20.

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

There is no funding to report for the current project. JYS receives funding from the Psi Chi Honor Society and the health policy research scholars program. JLS receives grant and research support from the National Institutes of Health (DP5OD28123), the Klingenstein Third Generation Foundation, the American Psychological Foundation, and Limbix, Inc. JLS is also under contract with New Harbinger Publications to co-author a therapeutic workbook for adolescents and with Oxford University Press to co-edit a book on low-intensity mental health interventions for youth. The authors report no other financial conflicts.

Author information

Affiliations

  1. Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA

    Jenna Y. Sung & Jessica L. Schleider

  2. Department of Psychology, American University, Washington, D.C, USA

    Corinne N. Kacmarek

Authors
  1. Jenna Y. Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Corinne N. Kacmarek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica L. Schleider
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jenna Y. Sung.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Pre-registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158621.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sung, J.Y., Kacmarek, C.N. & Schleider, J.L. Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review. Clin Child Fam Psychol Rev 24, 1–19 (2021). https://doi.org/10.1007/s10567-020-00333-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10567-020-00333-1

Keywords

  • Economic evaluations
  • Mental health programs
  • Child and adolescent mental health
  • Health policy
  • Systematic review