Presentation (CTI)

OBJECTIVES: Self-harm and suicide amongst adolescents are growing public health concerns. Studies on cost-effective approaches to address these are limited. We critically review the evidence on the cost-effectiveness of interventions to reduce suicide and self-harm amongst adolescents in high-resource settings to draw recommendations for practice and research.
METHODS: A systematic search (Embase, Medline, Scopus, Global Health, and Econlit; 01 Jan 2014 - 31 Dec 2025) was conducted to identify full economic evaluations published in English comparing adolescent self-harm and suicide interventions. Data extracted included interventions and comparators, outcomes used, and data sources for parameters. Studies were critically assessed using the Risk of Bias tools specific to the underlying data source (e.g., ROB for randomized trials and ROBIS for systematic reviews) and the JBI economic evaluations checklist.
RESULTS: Ten studies, evaluating a total of fifteen interventions, were included. All studies were assessed as being of good quality on the JBI checklist. Seven of eight studies assessed using the ROB 1 tool had concerns regarding participant and personnel blinding. Four had concerns regarding allocation concealment. Both studies assessed with the ROBIS tool were determined to have a low risk of bias. Untargeted preventive interventions were reported to be more cost-effective than those targeting specific groups (e.g., at-risk children). Three of six therapy-based interventions were reported as not cost-effective. The cost-effectiveness of the remaining interventions was mixed. This may be explained by four of the six studies using shorter time horizons (<1 year), which allow less time for benefits to accrue and to offset initial intervention costs.
CONCLUSIONS: Our review suggests that non-targeting preventive interventions are promising in terms of cost-effectiveness. However, given the small number of studies identified, further research is needed to confirm this finding. Additionally, more long-term research into different therapy-based interventions is needed to establish their cost-effectiveness.