Developing a Health-Economic Model to Assess Cost-Effectiveness of Preventive Interventions for Children of Parents With Mental Illness or Substance Use Disorder

Yara M Meijer; Ben F M Wijnen; Anne Kleijburg; Hendrika J Valkenburg; Anouk de Gee; Laura Shields-Zeeman; Frederick W Thielen

doi:10.1016/j.jval.2026.01.009

Developing a Health-Economic Model to Assess Cost-Effectiveness of Preventive Interventions for Children of Parents With Mental Illness or Substance Use Disorder

Value Health. 2026 Feb 2:S1098-3015(26)00034-3. doi: 10.1016/j.jval.2026.01.009. Online ahead of print.

Authors

Yara M Meijer¹, Ben F M Wijnen², Anne Kleijburg³, Hendrika J Valkenburg⁴, Anouk de Gee², Laura Shields-Zeeman⁵, Frederick W Thielen⁶

Affiliations

¹ Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Electronic address: y.m.meijer@vu.nl.
² Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
³ Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Maastricht University, Health Services Research, Maastricht, The Netherlands.
⁴ Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands.
⁵ Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Faculty of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands.
⁶ Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Erasmus School of Health Policy and Management and Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.

PMID: 41638314
DOI: 10.1016/j.jval.2026.01.009

Abstract

Objectives: Children of parents with a mental illness (COPMI) face a higher risk of developing mental disorders, leading to significant long-term societal and health-related costs. Although preventive interventions exist, few studies assess their cost-effectiveness, and, to our knowledge, none model long-term outcomes. This study aims to develop a Markov model to evaluate the cost-effectiveness of preventive interventions for COPMI in The Netherlands.

Methods: A decision-analytic model was constructed using data from the Avon Longitudinal Study of Parents and Children. The model simulates COPMI progression over time, with health states including healthy, depression/anxiety, comorbidity, remission, and death. The time horizon spans 28 years, from ages 7 to 35, and outcomes are evaluated from both healthcare and societal perspectives. Results are expressed as total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. A group-based cognitive behavioral therapy (GB-CBT) intervention was evaluated against a reference scenario.

Results: The preventive CBT intervention yielded an additional 0.02 QALYs at an additional cost of €188 per patient, resulting in an incremental cost-effectiveness ratio of €9495 per QALY. The intervention had a 74% probability of being cost-effective at a willingness-to-pay threshold of €20 000 per QALY.

Conclusions: The Markov model provides a flexible tool for evaluating the cost-utility of user-defined COPMI interventions to support informed decision making in mental health care. It is freely available for academic purposes from the authors upon request. Results suggest GB-CBT may be a cost-effective strategy for preventing mental disorders in COPMI.

Keywords: ALSPAC; COPMI; anxiety; cost-effectiveness; depression.