Economic evaluation of nine intersectoral strategies to improve youth mental health and alleviate financial burden in Colombia using system dynamics modelling.

Abstract

Objectives: Limited evidence exists for strategic actions in improving the youth population-level mental health, particularly in low- and middle-income countries. This study investigates the health and economic impacts of inter-sectoral 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 examined nine interventions compared to 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. GP mental health training and gatekeeper suicide prevention training could significantly improve mental health outcomes at an incremental cost-effectiveness ratio (ICER) below the threshold of 4,890 USD/QALY. However, simultaneously implementing all nine strategies could produce a synergistic effect, yielding the greatest benefit relative to business-as-usual with an incremental net monetary benefit of USD 465 million and an ICER of USD 586 per QALY gained.

Conclusions: Combined intersectoral mental health strategies were synergistic and resulted in optimum health outcomes relative to business-as-usual. 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 prioritise and allocate scarce resources in complex public health systems.