Economic Evaluation of Family-Focused Programs When Parents Have a Mental Health Problem: Methodological Considerations.

The nature of adverse effects of parental mental health problems and of the interventions to address them may require specific designs of economic evaluation studies. Nevertheless, methodological guidance is lacking. We aim to understand the broad spectrum of adverse effects from parental mental health problems in children and the economic consequences on an individual and societal level to navigate the design of economic evaluations in this field. We conducted a systematic literature search of empirical studies on children's adverse effects from parental mental illness. We clustered types of impact, identified individual and public cost consequences, and illustrated the results in an impact inventory. We found a wide variety of short- and long-term (mental) health impacts, impacts on social functioning and socioeconomic implications for the children individually, and adverse effects on the societal level. Consequently, public costs can occur in various public sectors (eg, healthcare, education), and individuals may have to pay costs privately. Existing evaluations in this field mostly follow standard methodological approaches (eg, cost-utility analysis using quality-adjusted life-years) and apply a short-time horizon. Our findings suggest applying a long-term time horizon (at least up to early adulthood), considering cost-consequence analysis and alternatives to health-related quality of life and quality-adjusted life-years as outcome measures, and capturing the full range of possible public and private costs. • Programs to prevent adverse effects of parental mental illness in children have shown benefits. Nevertheless, economic evaluations are scarce and methodologically challenging. • We provide an overview on the spectrum of adverse consequences of parental mental illness in children and society and give an orientation on how this knowledge may be translated into the design of an economic evaluation regarding perspective, study type, time horizon, and selection of costs and outcomes. • Economic evaluations of family-focused interventions when parents have a mental illness require careful design and possibly deviation from standard methods (eg, quality-adjusted life-years) to avoid decisions based on misleading cost-effectiveness results. [ABSTRACT FROM AUTHOR]