Economic Evaluation of 9 Intersectoral Strategies to Improve Youth Mental Health and Alleviate Financial Burden in Colombia Using System Dynamics Modeling

Andrea N Natsky; Adam Skinner; Laura Ospina-Pinillos; Esperanza Peña-Torres; Mónica Natalí Sánchez-Nítola; Débora Lucia Shambo-Rodriguez; Salvador Camacho; Adriane Martin-Hilber; Paul Crosland; Ian B Hickie; Jo-An Occhipinti

doi:10.1016/j.jval.2024.11.004

Economic Evaluation of 9 Intersectoral Strategies to Improve Youth Mental Health and Alleviate Financial Burden in Colombia Using System Dynamics Modeling

Value Health. 2024 Nov 28:S1098-3015(24)06765-2. doi: 10.1016/j.jval.2024.11.004. Online ahead of print.

Affiliations

¹ Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: andrea.natsky@sydney.edu.au.
² Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
³ Department of Psychiatry and Mental Health, Faculty of Medicine. Pontificia Universidad Javeriana, Bogotá, Colombia.
⁴ Faculty of Nursing, Pontificia Universidad Javeriana, Bogotá, Colombia.
⁵ Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
⁶ Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁷ Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia.

PMID: 39613257
DOI: 10.1016/j.jval.2024.11.004

Abstract

Objectives: Limited evidence exists for strategic actions in improving mental health at the youth population-level, particularly in low- and middle-income countries. This study investigates the health and economic impacts of intersectoral mental health programs to inform the optimal suite of interventions for young people in Bogotá, Colombia, where many are at risk of mental disorders and lack access to appropriate health services.

Methods: This study evaluated 9 interventions compared with business as usual over a projected 10-year time horizon using a system dynamics model developed through a participatory process involving diverse local stakeholders. Sensitivity analyses were performed to account for uncertainties from a healthcare payer perspective.

Results: Anti-bullying, community-based rehabilitation, and online mental health programs were dominant. General practitioner mental health training and gatekeeper suicide prevention training could significantly improve mental health outcomes at an incremental cost-effectiveness ratio below the threshold of US dollars $4890/quality-adjusted life-years. Nevertheless, simultaneously implementing all 9 strategies could produce a synergistic effect, yielding the greatest benefit relative to business as usual with an incremental net monetary benefit of $465 million and an incremental cost-effectiveness ratio of $586 per quality-adjusted life-years gained.

Conclusions: Combined intersectoral mental health strategies were synergistic and resulted in optimal health outcomes relative to business as usual. The system dynamics approach offers additional attributes to economic evaluation in mental health settings by considering capacity constraints, unintended consequences, and interactions between multiple interventions. It is a valuable approach for decision-makers to effectively and efficiently prioritize and allocate scarce resources in complex public health systems.

Keywords: decision analysis; economic evaluation; policy; systems modeling; youth mental health.