The economics of children’s mental health

Background: There is an increasing push towards policy-makers approving interventions for childhood mental disorders based on clinical effectiveness and cost considerations. To this end, high-quality economic evaluations of these interventions are starting to accumulate. Consequently, we set out to review the available data to help determine which prevention programs constitute the wisest use of limited public funds.Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of mental disorder prevention programs that also had an economic evaluation. Applying our inclusion criteria, we accepted four RCTs.Results: Coping With Stress resulted in significantly more depression-free days for participants with an average incremental cost-effectiveness ratio of id="mce_marker"0 per depression-free day. Fast Track significantly lowered the incidence of conduct disorder but only among the high-risk children. However, the cost per averted case of conduct disorder was still more than $752,000 for this group of children. Nurse Home Visitation resulted in significantly fewer serious behavioural problems many years after the program ended, including fewer criminal convictions. It also resulted in a net saving among the highest risk families by reducing other service use. Finally, Perry Preschool similarly resulted in less criminal activity as well as higher educational achievement and employment earning years after the program ended. It also produced a net savings.Conclusions: Prevention programs can not only avert needless suffering for children and families, they can also produce cost-savings for society.