Is the SELFIE intervention worth the financial investment, compared to doing nothing? Cost-effectiveness research answers this question by comparing the outcomes and financial costs between people who received the intervention and those who did not. The purpose of that is to see how much extra improvement the intervention delivers relative to its costs. Besides all costs of the intervention itself (for example programming the app and training the therapists), societal costs are included as well, such as healthcare use outside of SELFIE, and productivity loss (such as missing work). In short, an intervention is cost-effective if it leads to better outcomes without increasing total societal costs too much, or if it saves money.
From 2019 to 2021, the SELFIE intervention was tested for the first time among young people in the Netherlands in a Randomized Clinical Trial, meaning that participants were randomly assigned to a group that received the intervention and a group that did not (the control condition). These groups can then be compared in research. In the intervention group, young people used the SELFIE-app for six weeks, next to a weekly contact with a SELFIE-therapist. The aim of this intervention was to improve the self-esteem of young people who experienced childhood adversity, to set them up for a mentally healthier future. The SELFIE intervention has shown great efficacy in improving self-esteem and other outcomes, both short-term and long-term, but its cost-effectiveness was not yet evaluated.
This new publication is the first evaluation of SELFIE’s cost-effectiveness. To do that, all costs were first calculated. The number of times that people used mental health services and skipped workdays, for example, was linked to financial costs reported by national statistical agencies and costing manuals. Then, all the costs were compared to how much better young people were doing in terms of self-esteem and health-related quality of life. The results were also compared between subgroups (for example, participants who had treatment next to SELFIE, versus those who did not) and between types of costs (adding all of the costs in or just looking at service use costs). Measures and analyses were used that are widely acknowledged, and established guidelines for economic reporting were followed.
When we look at the overall results (so: all participants and all cost types combined), there is a 26% probability that it is good value at a lower societal budget (€20,000 per year of healthy life gained), rising to 49% at a higher societal budget (€50,000). Then, when we focus only on healthcare costs, the probability of cost-effectiveness is much higher (77%). In other words, the value for money is high when it comes to healthcare costs, but not when you also consider productivity at a job. This might be because work productivity is comparably less relevant in this age group. Future studies must also measure productivity at school, which is likely more relevant among young people.
For young people who were recruited via their practitioner in specialized mental health care, there was a high probability (87%) of the intervention being of good value. In other words, when participants recruited from the general population were not included, and the focus was only on participants recruited through their practitioner (again testing SELFIE participants versus control participants), the value for money was strong. This suggests that the SELFIE intervention may be most cost-effective for those who need support the most.
In conclusion, the cost-effectiveness of the SELFIE intervention looks promising from a healthcare perspective, and among young people in specialized mental health care, from this first trial in the Netherlands.
At this moment, a new trial of the SELFIE intervention is starting in YOUTHreach, where the cost-effectiveness will be re-tested in the Netherlands, and tested for the first time in other European countries. Would you like to stay updated? Perhaps you are interested in participating in the study yourself, are thinking of someone you know, or maybe you are just curious to read about the progress of this research. You can follow YOUTHreach online, subscribe to the newsletter via the contact page on this website, or leave us a message in the contact form.
Boonstra, A., Daemen, M., Osstyn, S., Handels, R., Drost, R., Postma, M., 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 exposed to childhood adversity: findings from a multi-centre randomized controlled trial. Psychological Medicine.
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