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

TY - JOUR

T1 - 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

AU - Boonstra, Anouk

AU - Daemen, Maud

AU - Osstyn, Sander

AU - Handels, Ron

AU - Drost, Ruben

AU - Postma, Mary Rose

AU - Hoes-van der Meulen, Iris

AU - Volbragt, Nele

AU - Nieman, Dorien

AU - Delespaul, Philippe

AU - van der Pluijm, Marieke

AU - Breedvelt, Josefien Johanna Froukje

AU - van der Gaag, Mark

AU - Lindauer, Ramon

AU - Boehnke, Jan

AU - van den Berg, David

AU - de Haan, Lieuwe

AU - Evers, Silvia

AU - Smit, Filip

AU - Bockting, Claudi

AU - van Amelsvoort, Therese

AU - Reininghaus, Ulrich

N1 - Publisher Copyright: © The Author(s), 2026.

PY - 2026/4/13

Y1 - 2026/4/13

N2 - 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.

AB - 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.

KW - Health economics

KW - Cost effectiveness

KW - Cost utility

KW - cost-effectiveness

KW - self-esteem

KW - cost-utility

KW - childhood adversity

KW - ecological Momentary Intervention

U2 - 10.1017/S003329172610395X

DO - 10.1017/S003329172610395X

M3 - Article

C2 - 41969051

SN - 0033-2917

VL - 56

JO - Psychological Medicine

JF - Psychological Medicine

M1 - e103

ER -