Abstract
Background: AWARE (Approaches for Wellbeing and Mental health Literacy: Research in Education) is a three-arm, parallel group cluster randomised controlled trial. It assessed the effectiveness of two interventions – YAM (Youth Aware of Mental Health) and The Guide – in addressing emotional difficulties and intended help-seeking, compared to usual practice, among year 9 students in England. This study evaluates the cost-effectiveness of YAM and The Guide, providing insights to inform policy decisions regarding the implementation of these mental health interventions in schools.
Methods: Cost-effectiveness was assessed using self-reported information from participants in the trial at baseline and two follow-ups – the first at 3-6 months after the start of intervention, and the second at 9-12 months post-intervention. Quality of life was measured using the Child Health Utility (CHU9D) index. Costs of delivering the interventions were calculated using the data provided by the delivery teams. Service use costs were calculated by multiplying frequency of service use – collected using a short version of the Client Service Receipt Inventory (CSRI) – and unit costs obtained from publicly available sources.
Outcomes: For both interventions, the difference in outcomes (i.e. change in quality-adjusted life years [QALYs] over time) between the intervention group and control group were very small. Changes in costs were likewise small.
Interpretation: Based on these small differences, at first follow-up, (3-6 months after start of intervention delivery) neither intervention is likely to be considered cost-effective. At second follow-up (9-12 months after intervention delivery was complete), YAM has a high probability of being considered cost-effective, with an incremental cost-effectiveness ratio (ICER) of around £23,000 per unit of improvement in the quality-of-life measure, which falls within the threshold (£20,000 to £30,000) as used by NICE.
Methods: Cost-effectiveness was assessed using self-reported information from participants in the trial at baseline and two follow-ups – the first at 3-6 months after the start of intervention, and the second at 9-12 months post-intervention. Quality of life was measured using the Child Health Utility (CHU9D) index. Costs of delivering the interventions were calculated using the data provided by the delivery teams. Service use costs were calculated by multiplying frequency of service use – collected using a short version of the Client Service Receipt Inventory (CSRI) – and unit costs obtained from publicly available sources.
Outcomes: For both interventions, the difference in outcomes (i.e. change in quality-adjusted life years [QALYs] over time) between the intervention group and control group were very small. Changes in costs were likewise small.
Interpretation: Based on these small differences, at first follow-up, (3-6 months after start of intervention delivery) neither intervention is likely to be considered cost-effective. At second follow-up (9-12 months after intervention delivery was complete), YAM has a high probability of being considered cost-effective, with an incremental cost-effectiveness ratio (ICER) of around £23,000 per unit of improvement in the quality-of-life measure, which falls within the threshold (£20,000 to £30,000) as used by NICE.
| Original language | English |
|---|---|
| Publisher | OSF Preprints |
| Number of pages | 15 |
| DOIs | |
| Publication status | Published - 24 Oct 2025 |
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