Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial

摘要: BACKGROUND One billion children live in war-affected regions of the world. We conducted first cost-effectiveness analysis an intervention for youth sub-Saharan Africa, as well a broader cost analysis. METHODS The Youth Readiness Intervention (YRI) is behavioural treatment reducing functional impairment associated with psychological distress among young persons. A randomized controlled trial was Freetown, Sierra Leone, from July 2012 to 2013. Participants (n = 436, aged 15-24) were YRI (n = 222) or care usual (n = 214). Functional indexed by World Health Organization Disability Assessment Scale; scores converted quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming societal perspective. Incremental ratios (ICERs) also expressed terms gains across dimensions mental health schooling. Secondary analyses explored whether effects largest those worst-off (upper quartile) at baseline. RESULTS Retention 6-month follow-up 85% (n = 371). $104 per participant. lower recipients, compared controls, following but not follow-up, yielded ICER $7260 QALY gained. At 8-month teachers' interviews indicated that recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting $431 additional year gained, better attendance (P = 0.007, OR 34.9) performance (P = 0.03, effect size = -1.31). cost-effective baseline, yielding $3564 CONCLUSIONS willingness-to-pay threshold three times average gross domestic product capita. However, results indicate translated into range benefits, such improved enrolment, captured outline areas modification improve future trials. TRIAL REGISTRATION clinicaltrials.gov Identifier: RPCGA-YRI-21003.