Cost-Effectiveness of a Universal School-Based Mental Health Prevention Program: An Economic Modeling Study in a Limited Income Context

Objective This study aims to evaluate the cost-effectiveness of a school-based mental health prevention program in a limited income context to inform investment decisions. Methods The Resourceful Adolescent Program, an evidence-based resilience intervention designed for adolescents, was culturally adapted as Happy House (HH) in a two-arm, controlled trial in selected high schools in Vietnam. A Markov model assessed HH’s cost-effectiveness in preventing depression compared with doing nothing from a societal perspective over 5-year, 10-year, and lifetime horizons. The model underwent face, internal, and cross-validation with experts in health economics, mental health, and education. Effect size was drawn from the HH trial, utility values from an EuroQol 5-Dimension 5-Level (EQ-5D-5L) survey of 1004 adolescents and systematic reviews, and costs from the HH trial and Vietnam data. Incremental cost-effectiveness ratios (ICERs) were expressed in 2020 Vietnamese dong (VND) per quality-adjusted life year (QALY) gained, with costs and benefits discounted at 3%. Sensitivity analyses and a scenario on nationwide HH scaling were also conducted. Results Compared with do-nothing, HH had ICERs of 43.8 million VND (US $5512), 30.4 million VND (US $3831), and 22.9 million VND (US $2886) per QALY gained over 5-year, 10-year, and lifetime horizons, respectively. Nationwide scaling reduced ICERs to 27.6 million VND (US $3470), 18.8 million VND (US $2370), and 13.5 million VND (US $1698) per QALY over the same periods. ICERs were sensitive to changes in effect size, disease incidence, and intervention costs. Sensitivity analyses demonstrated that the results were robust despite parameter uncertainty and variations in key assumptions Conclusions Investing in a universal school-based mental health prevention program is cost-effective compared with doing nothing in a limited income context such as Vietnam. Scaling up HH implementation amidst rising depression incidence further enhances the cost-effectiveness of this investment.