Israel Escudero-Castillo, Francisco Javier Mato Diaz, Ana Rodriguez-Alvarez
{"title":"The Effect of Being Unemployed on Mental Health: The Spanish Case.","authors":"Israel Escudero-Castillo, Francisco Javier Mato Diaz, Ana Rodriguez-Alvarez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The lack of work appeared to be linked to several symptoms related to poor mental health. Likewise, the reverse relationship, namely the influence of poor mental health on the risk of job loss, has also been analysed, i.e. distress could lead to a poorer work performance culminating in potential job loss. Thus, the bidirectional nature of the relationship between unemployment and mental health makes the accurate estimation of causal relationships a complex matter, leaving room for additional research on the subject.</p><p><strong>Aims of the study: </strong>The aim of this research is to analyse the influence that unemployment could have on mental health taking into account the bidirectional nature that exists between both concepts.</p><p><strong>Methods: </strong>In order to tackle the causal effect of being unemployed on mental health, we present a biprobit model taking into account the presence of dummy endogenous regressors and we compare these results with those obtained from a standard univariate probit. Our identification strategy exploits geographical information on the unemployment rates as instrument. We use Spanish cross-sectional data from the 2006, 2011 and 2017 years.</p><p><strong>Results: </strong>Based on the results, the paper concludes that unemployed persons in Spain could be subject to a 5.4% higher probability of suffering symptoms related to a common mental disorder (versus 11% obtained using a standard probit).</p><p><strong>Discussion: </strong>The results obtained confirm a negative impact of unemployment situation on mental health. In other words, the probability of unemployed people suffering a mental disorder seems superior to that for individuals with a job. Moreover, the marginal effect obtained from a univariate probit model without the possibility of controlling the mental health selection effects, proves the existence of a problem of simultaneity that would have overestimated the effect of being unemployed on mental health.</p><p><strong>Implications for health care provision: </strong>It is hoped that the conclusions obtained here prove useful in the implementation of specific mental health care provision aimed at unemployed people. In this context, the evidence obtained should result in the incorporation of health assistance as an essential part in response to the needs of this collective.</p><p><strong>Implications for health policies: </strong>These special needs of unemployed people should be contemplated not only from a health care provision but also as part of a broader system that incorporates the mental health care of unemployed persons as part of more general public health policies. Finally, these results suggest that mental health-related objectives should be considered when planning, implementing, and evaluating active labour market policies for the unemployed.</p><p><strong>Implications for further research: </strong>The length and severity of the last recession, toget","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"25 3","pages":"79-89"},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cost-Effectiveness Analysis of School-Based Treatments for Anxiety Disorders.","authors":"Golda S Ginsburg, Jeffrey E Pella, Eric Slade","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>School-based treatments for anxiety disorders are needed to address barriers to accessing community-based services. A key question for school administers are the costs related to these treatments.</p><p><strong>Aims of the study: </strong>This study examined the cost-effectiveness of a school-based modular cognitive behavioral therapy (M-CBT) for pediatric anxiety disorders compared to school-based treatment as usual (TAU).</p><p><strong>Methods: </strong>Sixty-two school-based clinicians in Maryland and Connecticut were randomized (37 in CBT; 25 in TAU), trained, and enrolled at least one anxious student (148 students in CBT; 68 in TAU). Students (N = 216) were ages 6-18 (mean age 10.9); 63.9% were non-Hispanic White race-ethnicity; and 48.6% were female. Independent evaluators (IEs) assessed outcomes at post treatment and at a one-year follow up. Anxiety related costs included mental health care expenses and the opportunity costs of added caregiver time and missed school days.</p><p><strong>Results: </strong>The overall M-CBT ICER value of $6917/QALY reflected both lower costs for days absent from school (mean difference: $--117 per youth; p = 0.045) but also lower QALY ratings (mean difference: -0.024; p = 0.900) compared with usual school counseling. Among youth with more severe anxiety at baseline, M-CBT had a more favorable ICER ($-22,846/QALY). Other mental health care costs were similar between groups (mean difference: $-90 per youth; p = 0.328).</p><p><strong>Discussion: </strong>Although training school clinicians in M-CBT resulted in lower costs for school absences, evidence for the cost effectiveness of a modular CBT relative to existing school treatment for pediatric anxiety disorders was not robustly supported. Findings suggest school-based M-CBT is most cost effective for youth with the highest levels of anxiety severity and that M-CBT could help reduce the costs of missed school. Interpretations are limited due to use of retrospective recall, lack of data on medication use, and small sample size.</p><p><strong>Implications for health care provision and use: </strong>Schools may benefit from providing specialized school-based services such as M-CBT for students with the highest levels of anxiety.</p><p><strong>Implications for health policies: </strong>Investment decisions by schools should take into account lower costs (related to school absences), the costs of training clinicians, and student access to CBT in the community.</p><p><strong>Implications for further research: </strong>Replication with a larger sample, service use diaries, and objective school and medical records over a longer period of time is warranted.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"25 3","pages":"91-103"},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Certificate of Need and Inpatient Psychiatric Services.","authors":"James Bailey, Eleanor Lewin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Certificate of need (CON) laws require would-be healthcare providers to obtain the permission of a state board before opening or expanding. 35 US states operate some type of CON program, though they vary widely in the specific services or equipment they target, with 25 states requiring CON for psychiatric services.</p><p><strong>Aims of the study: </strong>We provide the first empirical estimates on how CON affects the provision of psychiatric services.</p><p><strong>Methods: </strong>We use Ordinary Least Squares regression to analyze 2010-2016 data on psychiatric CON from the American Health Planning Association together with data on psychiatric facilities and services from the National Mental Health Services Survey.</p><p><strong>Results: </strong>We find that CON laws targeting psychiatric services are associated with a statistically significant 0.527 fewer psychiatric hospitals per million residents (20% fewer) and 2.19 fewer inpatient psychiatric clients per ten thousand residents (56% fewer). Psychiatric CON is also associated with psychiatric hospitals being 5.35 percentage points less likely to accept Medicare. Our estimates for CON's effect on the number of inpatient psychiatric beds per ten thousand residents and the likelihood of psychiatric hospitals accepting Medicaid, private insurance, or charity care (no charge) are negative but not statistically significant.</p><p><strong>Discussion: </strong>CON laws may substantially reduce access to psychiatric care. A limitation of our study is that there is almost no variation in which states have psychiatric-related CON laws during the time period of our data (New Hampshire is the only state to change its psychiatric services CON requirement in this period, repealing its CON program entirely in 2016). This precludes the use of preferred econometric techniques such as difference-in-difference.</p><p><strong>Implications for health policies: </strong>Our results indicate that CON laws may reduce access to inpatient psychiatric care. State policymakers should consider whether CON repeal could be a simple way of enhancing access to psychiatric care.</p><p><strong>Implications for further research: </strong>While hundreds of articles have examined the effects of CON laws, we believe ours is the first to provide empirical estimates of their effects on mental health care specifically. We hope it is not the last.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 4","pages":"117-124"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39726824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"PERSPECTIVE: Current US COVID-19 Pandemic Substance Use Research and Ideas for Research That May Help Us Learn More.","authors":"Sarah Q Duffy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic likely had and will continue to have severe implications for those who use addictive substances, have substance use disorders, or use substance use related health care services. Policy and services research, particularly health economics research, can illuminate these effects on individuals, uncover the effects of the rapidly imposed changes in policy on how services were delivered, promote efficient and effective provision of services, and inform responses to future pandemics.</p><p><strong>Aims of the study: </strong>To identify potential substance use related effects of COVID-19 and pandemic mitigation policies, highlight themes in current research, and suggest areas for further high-quality policy and services research, with an emphasis on health economics research.</p><p><strong>Methods: </strong>Review of recent published commentaries, government documents, and initial research findings to describe potential impacts, and review of current COVID-19 related research grants funded by the United States National Institutes of Health to identify themes.</p><p><strong>Results: </strong>Potential impacts include increased risk for and severity of COVID-19 illness among those who use substances, mitigation measures causing increased substance use and development of use disorders, and fundamental changes in the way treatment is provided. Current research may provide initial findings that may be useful in generating hypotheses for future rigorous research.</p><p><strong>Discussion: </strong>Research on these and other areas could enhance our fundamental understanding of the needs of individuals who use substances and how to best address those needs in the most efficient, effective way. Though this brief review highlights some areas of potential interest, its focus is mainly on treatment and on the United States context. Research on additional services and contexts likely could inform advances as well.</p><p><strong>Implications for health care provision and use: </strong>Health care providers rapidly and under considerable stress made needed changes that likely mitigated SARS-CoV-2 transmission. Rigorous research can help determine what worked best and for whom, what could be kept, and what might better be discarded.</p><p><strong>Implications for health policies: </strong>Research on the effects of mitigation policies may inform the development of policies to reduce negative effects when addressing future pandemics, whether to permanently allow at least some substance use treatment flexibilities, and whether research on other restrictive policies might lead to improvement.</p><p><strong>Implications for further research: </strong>This extraordinary event brought into sharp relief the numerous vulnerabilities of those who use substances and those with substance use disorders while also leading to vast changes in the services that address them. Rigorous research into those effects could result in si","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 4","pages":"125-135"},"PeriodicalIF":1.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794236/pdf/nihms-1748810.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39726826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"PERSPECTIVE: A Mental Health Services Research Agenda in the Era of COVID-19: Steadfast Commitment to Addressing Evolving Challenges.","authors":"Michael C Freed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Decades of research that predate the COVID-19 pandemic demonstrate that most people with mental health needs are not receiving adequate care. The inequities between those who need care and those who receive adequate care are larger for racial and ethnic minority groups and people living in underserved communities. The pandemic is associated with an exacerbation of these inequities, resulting in increased morbidity and mortality for the most vulnerable populations.</p><p><strong>Aims: </strong>This Perspective summarizes longstanding and evolving challenges to the provision of high quality care for people with mental illness, describes the National Institute of Mental Health's (NIMH) commitment to addressing those challenges, and embeds salient research priorities most germane to the health policy readership of this journal.</p><p><strong>Methods: </strong>Example funding announcements and extant funding priorities are highlighted to demonstrate NIMH's commitment to health services research during the pandemic. The collaborative care model is presented as an evidence-supported service delivery model that could be delivered via telehealth. Recent studies that compare the utilization of routine telehealth services during the pandemic, when compared to in-person services pre-pandemic, are summarized.</p><p><strong>Results: </strong>In FY2020, NIMH invested $171,194,275 in health services research. Over the past two years, NIMH led or participated on dozens of funding announcements that call for mental health services research to help improve the provision of care for people with mental illness. Service delivery models like collaborative care can offer effective intervention via telehealth. The practice community can deliver routine services via telehealth at volumes similar to pre-pandemic in-person levels. However, wide variation in telehealth utilization exists, with inequities associated with racial and ethnic groups and underserved rural locations. A limitation is that clinical outcomes are not routinely available from administrative datasets.</p><p><strong>Discussion: </strong>There continues to be an urgent need for health policy research and collaboration with the health policy community as part of the research enterprise.</p><p><strong>Implications for health care provision and use: </strong>NIMH encourages and often requires strong research practice partnerships to help ensure findings will be of value to end users and make their way into the practice setting. There is a need to study pandemic related changes in financing, delivery, receipt, and outcomes of mental health care.</p><p><strong>Implications for health policies: </strong>Despite robust evidence, clinical practice guideline recommendations, and established financing mechanisms, uptake of service delivery models that can be delivered in part or in full via telehealth (e.g., the collaborative care model) is poor.</p><p><strong>Implications for further","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 4","pages":"137-142"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39726827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hesham Farouk Elarabi, Hamad Al Ghaferi, Nael Hasan, Amanda J Lee, Mansour Shawky, Helal Al Kathiri, Abuelgasim Elrasheed, Samya Al Maamari, Tarek A Gawad, Doaa Radwan, Abdu Adem, John Marsden
{"title":"Exploratory Economic Evaluation of Buprenorphine Treatment in Opioid Use Disorder.","authors":"Hesham Farouk Elarabi, Hamad Al Ghaferi, Nael Hasan, Amanda J Lee, Mansour Shawky, Helal Al Kathiri, Abuelgasim Elrasheed, Samya Al Maamari, Tarek A Gawad, Doaa Radwan, Abdu Adem, John Marsden","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Burden of opioid use disorder (OUD) is expressed in economic values or health metrics like Disability Adjusted Life Years (DALYs). Disability Weight (DW), a component of DALYs is estimated using economic methods or psychometric tools. Estimating DW at patient level using psychometric tools is an alternative to non-population specific DW overestimated by economic methods. Providing Medication Assisted Treatment (MAT) using buprenorphine/naloxone film (BUP/NX-F) for OUD is limited by financial constraints.</p><p><strong>Aim: </strong>To estimate the burden of OUD at patient level and explore the cost-benefit of two buprenorphine treatment interventions.</p><p><strong>Methods: </strong>The present study was conducted alongside a randomized controlled trial of 141 adults with OUD stabilized on BUP/NX-F and randomized to BUP/NX-F with Incentivized Abstinence and Adherence Monitoring (experimental, n=70) and BUP/NX-F in usual care (control, n=71). The cost of illness was estimated applying a societal perspective. The Impairment Weight (IW) was estimated over a '0' to '1' scale, where '0' represents no impairment and '1' full impairment using the Work and Social Adjustment Scale (WSAS).</p><p><strong>Results: </strong>Median (interquartile range) annual cost of OUD per participant was AED 498,171.1 (413,499.0 -635,725.3) and AED 538,694.4 (4,211,398.0 - 659,949.0) in the experimental and control groups, respectively (p=0.33). Illicit drug purchase represented 60 % of the annual cost of illness. At baseline, the mean Impairment Weight (IW) was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At end of the study, the IW was 0.26 (SD 0.28) representing 51% reduction in the experimental group compared to 0.42 (SD 0.33) in the control group representing a 27% reduction. Excluding imprisonment, the cost-benefit of treatment was not realized. In contrast, accounting for imprisonment, cost benefit expressed as a return-on-investment was established at 1.55 and 1.29 in the experimental and control groups, respectively.</p><p><strong>Implications for mental health policy: </strong>Cost benefit analysis can serve as a simple and practical tool to evaluate the cost benefit of treatment interventions. Demonstrating the cost benefit of buprenorphine treatment has the potential to facilitate public funding and accessibility to opioid assisted treatment.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"89-95"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"PERSPECTIVE: The Digital Health App Policy Landscape: Regulatory Gaps and Choices Through the Lens of Mental Health.","authors":"Kelila Kahane, Josie François, John Torous","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Interest in and use of mental health apps have grown over the past decade, and now further with the COVID-19 pandemic. Digital mental health offers potential to increase access to care, but tangible risks around safety and poor efficacy remain common.</p><p><strong>Methods: </strong>We conduct a select analysis of U.S. and international published evidence, government websites, grey literature, and media outlets. We present the marked discordance around digital mental health policy, as these frameworks grapple with the challenges of regulating in this sphere.</p><p><strong>Results: </strong>Across the world, there is no consensus around evaluation with countries piloting or proposing different models. Common barriers include the defining the scope and risk of health apps, creating processes able to update evaluation with software updates, lacking better data to inform evaluation, and educating users to the risks and benefits.</p><p><strong>Discussion: </strong>We propose four next steps for guiding any future policy: (i) clear clarification of the categorical status of mental health apps; (ii) objective methodology for assessing apps on a premarket basis which does not solely rely on self-reporting; (iii) well-designed, detailed procedures for iterative post-market app review; (iv) clinician and patient education which empowers users to make smart mental health app choices.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"101-108"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samuel H Zuvekas, Chandler B McClellan, Mir M Ali, Ryan Mutter
{"title":"LETTER: Medicaid Expansion and Mental Health Care and Coverage: Reply.","authors":"Samuel H Zuvekas, Chandler B McClellan, Mir M Ali, Ryan Mutter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"109-111"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"COMMENTARY: Medicaid Expansion and Mental Health Care and Coverage.","authors":"Richard G Frank","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 3","pages":"97-99"},"PeriodicalIF":1.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marta Wilson-Barthes, Stavroula A Chrysanthopoulou, Lukoye Atwoli, David Ayuku, Paula Braitstein, Omar Galárraga
{"title":"Cost-Effectiveness of Care Environments for Improving the Mental Health of Orphaned and Separated Children and Adolescents in Kenya","authors":"Marta Wilson-Barthes, Stavroula A Chrysanthopoulou, Lukoye Atwoli, David Ayuku, Paula Braitstein, Omar Galárraga","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Institutionalization has shown contradictory effects on the mental health of orphaned and separated children and adolescents (OSCA) in sub-Saharan Africa. There is a paucity of data surrounding the cost-effectiveness of different care environments for improving OSCA's mental health.</p><p><strong>Aims of the study: </strong>The goal of this analysis was to evaluate the cost-effectiveness of Charitable Children's Institutions (orphanages) compared to family-based settings serving OSCA in East Africa in terms of USD/unit reduction in mental health diagnoses (depression, anxiety, post-traumatic stress disorder, suicidality) and quality-adjusted life-year (QALY) gained.</p><p><strong>Methods: </strong>This economic analysis was conducted from a societal perspective as part of the Orphaned and Separated Children's Assessments Related to their (OSCAR's) Health and Well-Being Project, a 10-year longitudinal cohort study evaluating the effects of different care environments on OSCA's physical and psychological health in western Kenya. Cost data were ascertained from 9 institutions and 225 family-based settings in the OSCAR cohort via survey assessments, budget reports, and expert interviews. Monthly per-child costs were calculated as the sum of recurrent and capital costs divided by the environment's maximum residential capacity, and cost differences between care environments were estimated using two-part models. Mental health effectiveness outcomes were derived from prior survival regression analyses conducted among the OSCAR cohort. We used Child Depression Inventory Short-Form scores at baseline and follow-up to calculate the number of depression-free days (DFDs) over the follow-up period, and translated DFDs into QALYs using established utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in monthly per-child cost divided by the difference in each mental health outcome, comparing institutions to family-based settings. Sampling uncertainty in the ICERs was handled using nonparametric bootstrapping with 1,000 replications. We assumed a willingness-to-pay threshold of three times Kenya's per capita gross domestic product.</p><p><strong>Results: </strong>Charitable Children's Institutions cost USD 123 more on average than family-based settings in terms of monthly per-child expenditures (p<0.001). Compared to family-based care, institutional care resulted in an ICER of USD 236, USD 280, USD 397, and USD 456 per unit reduction in depression, anxiety, PTSD, and suicidal diagnosis among OSCA, respectively. The incremental cost per additional QALY was USD 4,929 (95% CI: USD 3096 -- USD 6740). The probability of Charitable Children's Institutions being more cost-effective than family-based settings was greater than 90% for willingness-to-pay thresholds above USD 7,000/QALY.</p><p><strong>Discussion: </strong>Only a subset of institutions in the cohort were willing to provide budgetary ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 2","pages":"31-41"},"PeriodicalIF":1.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39251782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}