Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Psychological medicine
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
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.
14 Apr 2026
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The effect of managed transition on the proportion of young people transitioning from CAMHS to AMHS: Analysis of the Milestone Cluster Randomised Clinical Trial
BACKGROUND: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is poorly managed, with discontinuity of care commonplace, leading to poorer outcomes, while evidence-based interventions to improve transition are scarce. This study is a secondary analysis of the MILESTONE trial, aiming to determine whether managed transition increases the proportion of young people who appropriately transition from CAMHS to AMHS. METHODS: The MILESTONE trial was a multicenter, two-arm, cluster-randomized controlled trial across eight countries at 40 CAMHS sites to compare usual care (UC) to managed transition (MT). MT consisted of training, identification, and assessment of transition readiness and appropriateness. Eligible participants were receiving CAMHS care, IQ ⩾ 70 and within 1 year of their service transition boundary. CAMHS sites were randomized 2:1 between UC and MT. The main outcome was whether participants were receiving care from AMHS at 15 months follow up. RESULTS: The MILESTONE study included 793 participants, 552 receiving UC and 241 receiving MT. In the MT group, 24.9% transitioned to AMHS at 15 months compared to 14.2% in the UC group (p = 0.002), and appropriate transitions (in those with a need for transition at baseline or ongoing clinical need at 15 months) were 32.3% in the MT group compared to 16.4% in the UC group (p < 0.001). CONCLUSIONS: A higher proportion of the MT group transitioned to AMHS at 15 months, and there was a higher proportion of appropriate transitions compared to UC. Clinicians and services should consider the incorporation of MT into routine clinical care.
7 Apr 2026
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