Cost-utility and cost-effectiveness of SELFIE, a transdiagnostic ecological momentary intervention for improving self-esteem in youth aged 12-26 years exposed to childhood adversity: Findings from a multicenter randomized controlled trial

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: ICER €1,219 per improved point of self-esteem; ICUR €53,986 per QALY gained (societal perspective)

• Primary Outcome: Cost-effectiveness and cost-utility of SELFIE intervention

• Nnt Or Sensitivity: 26% probability of cost-effectiveness at €20,000/QALY threshold; 49% at €50,000/QALY threshold (societal perspective)

• Confidence Interval: Not reported in abstract

Clinical Application

Digital intervention format enhances accessibility and scalability, though cost-effectiveness varies by healthcare system perspective and patient population Relevant to Australian youth mental health services and headspace centres. Cost-effectiveness thresholds align with Australian health economic evaluation standards. May complement existing digital mental health initiatives under the Digital Mental Health Gateway Adolescents and young adults (12-26 years) with low self-esteem and childhood adversity history, particularly those in specialized mental health services

Abstract

BACKGROUND: A novel transdiagnostic blended Ecological Momentary Intervention (EMI) for improving self-esteem in youth who experienced childhood adversity has shown beneficial effects. However, evidence on the cost-effectiveness of SELFIE and EMIs overall is lacking. METHODS: In this RCT-based economic evaluation, participants aged 12-26 years with low self-esteem (<26 on the Rosenberg Self-Esteem Scale [RSES]) and experienced childhood adversity were recruited from specialized mental health services and the general population and randomly allocated to CAU (control condition) or CAU + SELFIE (experimental condition). The Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (TiC-P), the RSES, and EQ-5D-5L were assessed at baseline, post-intervention, and 6-, 18-, and 24-month follow-up. Incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, and acceptability curves, were generated. Sensitivity and subgroup analyses assessed robustness. RESULTS: From a societal perspective, the ICER presented €1,219 per improved point of self-esteem, and the ICUR presented €53,986 per QALY gained. The probability of cost-effectiveness was 26% at a willingness-to-pay (WTP) threshold of €20,000/QALY and 49% at €50,000/QALY. At €50,000/QALY, the probability of cost-effectiveness was 77% from a healthcare perspective (ICUR €15,671/QALY gained) and 87% for participants recruited from specialized mental health services (ICUR €-14,567/QALY gained). CONCLUSIONS: At the societal level, the SELFIE intervention exceeded the WTP threshold. Tests for robustness showed higher probabilities of cost-effectiveness from a healthcare perspective, likely reflecting the absence of educational productivity loss costs in the societal perspective, and in youth recruited from specialized mental health services. The innovative field of blended EMIs yields encouraging first results, urging more cost-effectiveness research.

References

1. 1.Boonstra, A., Daemen, M., Osstyn, S., Handels, R., Drost, R., Postma, M. R., Hoes-van der Meulen, I., Volbragt, N., Nieman, D., Delespaul, P., van der Pluijm, M., Breedvelt, J. J. F., van der Gaag, M., Lindauer, R., Boehnke, J., van den Berg, D., de Haan, L., Evers, S., Smit, F., Bockting, C., van Amelsvoort, T., & Reininghaus, U. (2026). Cost-utility and cost-effectiveness of SELFIE, a transdiagnostic ecological momentary intervention for improving self-esteem in youth aged 12-26 years exposed to childhood adversity: Findings from a multicenter randomized controlled trial. *Psychological Medicine*. https://doi.org/10.1017/S003329172610395X