Economic evaluation of mental health interventions among crisis‑affected groups: a systematic review

Abstract Background There is a high global burden of mental health disorders and widespread gaps in services. Crisis-affected populations are at particular risk and suffer high levels of unmet need. While evidence of the effectiveness of mental health and psychosocial support (MHPSS) interventions is growing, there is limited economic evidence to guide implementation and promote investment. This systematic review aimed to appraise findings on cost-effectiveness and assess the quality of available evidence. Methods Five databases were searched following PRIMSA guidelines. Full economic evaluations of MHPSS interventions among crisis-affected populations published in peer-reviewed journals between January 2000 and June 2024 were included. The quality of the studies and compliance with reporting standards was assessed using the BMJ and CHEERS 2022 checklists. Results 3,517 records were identified but only ten studies met inclusion criteria. Of these, seven were published since 2020. One study was from a low-income country while six were from high-income countries. The majority report cost-effectiveness but the small number, combined with methodological differences and contrasting designs, make drawing conclusions difficult. A key factor influencing cost-effectiveness appears to be baseline characteristics of participants and, therefore, how studies target interventions; but there is insufficient evidence to draw firm conclusions. The key finding is that evidence is weak, especially regarding low- and middle-income countries; and the main recommendation is that research funders and donors should encourage greater use of economic methods as a part of routine evaluation. Conclusions Economic evaluations of MHPSS interventions for crisis-affected populations remain extremely limited. Consistent support for incorporating economic methods into programme evaluation, particularly in low-resource settings, is vital to build an evidence-base that can inform effective resource allocation. Key messages • Economic evaluations of mental health and psychosocial support (MHPSS) interventions for crisis-affected populations remain extremely limited. • Incorporating economic methods into MHPSS programme evaluation, particularly in low-resource settings, is vital for building an evidence-base that can inform effective resource allocation.