Jackson-Morris Angela, Meyer Christina L, Morgan Antony, Stelmach Rachel, Jamison Leah, Currie Candace
Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA.
Glasgow Caledonian University, London, UK.
Eur J Public Health. 2024 Feb 5;34(1):107-113. doi: 10.1093/eurpub/ckad193.
Adolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10-19 years) and examined intervention affordability and readiness.
Interventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework.
Over 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and 'implementation ready' and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years.
The economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England's annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness.
英国青少年心理健康需求急剧增加，需求超过了治疗可及性。本研究对预防和治疗青少年（10至19岁）精神障碍干预措施的健康和经济投资回报率（ROI）进行了比较评估，并考察了干预措施的可负担性和准备情况。
通过回顾已发表文献和灰色文献确定干预措施。采用马尔可夫模型跟踪模拟的青少年队列，以估计实施成本以及健康、教育和经济效益。评估干预措施的可负担性，将每个青少年的年度成本与英国国家医疗服务体系（NHS）的人均支出进行比较，并由一个专家小组使用经过验证的框架评估干预措施的准备情况。
在10年和80年的时间范围内，治疗轻度焦虑和轻度抑郁的干预措施最具成本效益，个人终身投资回报率最高（分别为5822英镑∶1英镑和257英镑∶1英镑）。预防焦虑和抑郁最具可负担性且“已准备好实施”，并带来最高的健康和经济效益。一个优先方案（预防焦虑和抑郁；治疗轻度焦虑和轻度抑郁）在10年内可避免500万个伤残调整生命年（DALYs），投资回报率为15英镑∶1英镑，或在80年内避免1150万个伤残调整生命年（投资回报率为55英镑∶1英镑）。
预防和治疗常见青少年精神障碍带来的经济效益在10年内相当于2021年英国国家医疗服务体系年度支出的25%，在80年内相当于91%。预防和早期治疗焦虑和抑郁的投资回报率最高，且实施准备情况良好。
