Abstract
To review the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide, to support evidence based societal resource allocation. A systematic review of economic evaluations within mental health and suicide prevention was conducted including studies published between January 2000 and November 2018. The studies were identified through Medline, PsychINFO, Web of Science, the National Health Service Economic Evaluation Database and Health Technology Assessment. The quality of relevant studies and the transferability of their results were assessed using a criterion set out by the Swedish Agency for Health Technology Assessment. Nineteen studies of moderate to high quality were included in this review, which evaluated 18 interventions in mental health and four interventions in suicide prevention. Fourteen (63%) of all interventions were cost-effective based on the conclusions from original papers. None of the studies that evaluated suicide prevention was of high quality. The interventions largely focused on psychological interventions at school, the workplace and within elderly care as well as screening and brief interventions in primary care. Nine studies (around 50% of included articles) had a high potential for transferability to the Swedish context. Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society, but high-quality evidence on the cost-effectiveness of suicide prevention is limited.
Highlights
Mental health problems account for a substantial burden of disease globally, with the World Health Organization predicting that by 2030, mental health problems will be the highest ranking disease area in terms of burden in affluent countries (Mathers and Loncar 2006)
Context relevant strategies spanning the broad spectrum of prevention, including both population-based interventions and interventions targeting high-risk individuals, are called for to reduce the burden associated with mental health problems
The aims of this study were: (1) to review the current literature on economic evaluations of public health interventions targeting the prevention of mental health problems and suicidal thoughts and actions, (2) to assess the transferability of the results to the Swedish context
Summary
Mental health problems account for a substantial burden of disease globally, with the World Health Organization predicting that by 2030, mental health problems will be the highest ranking disease area in terms of burden in affluent countries (Mathers and Loncar 2006). As any public health approach, mental health interventions intend to promote or protect mental health or prevent mental ill health in communities or populations. Studies on mental ill health and its associated economic burden draw attention to the substantial consequences of mental health problems. They cannot answer the question of whether investing resources into preventing such problems is an economically sound use of scarce resources compared to their alternative use or application. For this purpose, evidence from economic evaluations should be applied, whereby benefits and costs of alternative interventions are considered to aid decision-makers in prioritizing and allocating resources (Drummond et al 2005). Arguments have been put forward to examine the economic case of all areas of public health and health promotion (Gallagher 2005), and while some studies have been conducted in these areas, such evaluations remain scarce compared with healthcare interventions (McDaid and Needle 2009)
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