Cost-effectiveness of digital health interventions for child and adolescent mental health: a rapid review and narrative synthesis

Obse, Amarech G, Mankee-Williams, Anna ORCID: https://orcid.org/0000-0002-0829-8441, McCrone, Paul, Bhui, Kamaldeep, Fazel, Mina, Pavarini, Gabriella, Harriss, Eli, Shakoor, Sania, Fancourt, Daisy, Morgan, Craig, Hosang, Georgina, Hugh Jones, Siobhan, Havers, Laura, Ma, Minua Eunice and Smith, Lindsay (2025) Cost-effectiveness of digital health interventions for child and adolescent mental health: a rapid review and narrative synthesis. European Child & Adolescent Psychiatry, na. ISSN 1018-8827 (Submitted)

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Abstract / Summary

Access to mental health care is limited for many populations. Various forms of digital health interventions (DHI) have been introduced as an attempt to address these unmet mental healthcare needs. However, the evidence on the cost effectiveness of DHI for mental health is inconclusive, especially for children and adolescents.
Objective: This rapid review synthesises the evidence on the cost-effectiveness of DHI for supporting of poor mental health in children and adolescents.
Method: A literature search was carried out in MEDLINE, PsycINFO using Ovid platform. The search was restricted to peer-reviewed studies published in English between Jan 2018 to October 2023. Studies entered the review if they included cost effectiveness data on digital intervention for child and adolescent mental health against at least one comparator.
Results: Titles and abstracts of 902 records were screened and 11 studies met the criteria for inclusion. Studies were predominantly conducted in Europe. The focal outcomes in the studies included reduction in symptoms linked to depression, anxiety, obsessive compulsive disorder, and alcohol use. Most studies evaluated computerised cognitive behaviour therapy (CBT) or interventions that included aspects of CBT. Interventions were mainly delivered in the form of modules using text messaging, narration, illustrations, or videos, and one study included a gaming element. Four of the studies found the interventions to be dominant (cost saving and more effective) with respect to at least one outcome measure, and one found the intervention was not cost effective. For the remaining studies, the probability of cost effectiveness varied between 65-100%. Measures of effect (response to treatment or quality adjusted life years (QALYs)) and costing perspectives influenced cost-effectiveness of interventions.
Discussion: There is some evidence to suggest digital health interventions hold the potential to expand and extend mental health support for the younger generations with minimal therapist involvement. Yet, the evidence is not conclusive due to short follow up periods, variability in the methodological approaches and reporting of results. To fully evaluate cost-effectiveness, there is a need for further studies to focus on DHI in representative samples, in specific sub-groups of populations (e.g. urban, rural), with longer follow-up periods, and with varying levels of in-person guidance. Furthermore, implications of DHI on equity of access, impact of DHI on the wider health system, ethical implications related to digital access and shifts in responsibility must be concurrently addressed.
Conclusion: DHIs could serve as the first contact in the healthcare system for mild to moderate mental health problems improving children and adolescents’ access to therapies. However, any developments in this regard should address any structural disadvantage in access to DHIs due to digital poverty. High quality evidence on cost-effectiveness of DHIs with comparable methodological approaches is needed to inform implementation decisions.

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