Abstract

Objectives

To help address the youth mental health crisis affecting many countries, there is an opportunity for planners to use formalized priority-setting frameworks and sophisticated modeling tools to guide their investment decisions. The objective of this study was to explore how different types of system constraints affected the optimal configuration of existing services and new interventions and to estimate the downstream health and cost consequences for each of the scenarios.

Methods

Constrained optimization analysis was used within a system dynamics modeling framework to systematically test the cost effectiveness of seven scenarios varying existing mental health services capacity growth, new interventions targeted at youths, and budget constraints on the amount of investment funds available for new interventions. Incremental net monetary benefit was the outcome selected to be optimized. Both healthcare and societal perspectives were adopted, and costs were in 2020 to 2021 Australian dollars.

Results

Allowing existing services to expand beyond their long-run average growth rates and implementing 5 of the interventions resulted in the following outcomes accumulated over 11 years compared with business as usual: 16 139 quality-adjusted life-years gained, 294 (13%) suicide deaths avoided, 41 663 (30%) mental-health related emergency department presentations avoided, and 5869 (17%) self-harm hospitalizations avoided. Combined with an investment of AUD$36.6 million in new interventions, total cost savings (societal perspective) were AUD$731.3 million, and incremental net monetary benefit (ie, overall economic value, societal perspective) was AUD$2.07 billion.

Conclusions

The estimates of overall economic value provide a rationale and support for greater investments in mental health and guidance for the implementation of regional mental health system reform.