Cost-Effectiveness of the Remote Primary Care and Psychiatry Model (MAP-PSI) for Depression in Youth Living in Rural and Indigenous Communities

Abstract

Background: Community- and school-based interventions focused on mental health promotion and early detection of depressive symptoms have proven to be cost-effective. Our objective was estimated the costeffectiveness ratio of the remote and pilot Primary Care and Psychiatry Model (MAP-PSI) compared with community usual care (CUC) in a rural municipality in Mexico.

Methods: We analyzed all adolescents and young adults aged 15–25 years who received care between November 2023 and November 2024. Effectiveness measures included care-seeking behavior, school absenteeism prevented, suicide attempts avoided and suicides prevented. Direct and indirect costs including lost workdays, were considered. Incremental Costs-Effectiveness Ratios (ICERs) and deterministic sensitivity analyses were performed.

Results: Of 1057 recruited participants, 932 completed screening (88.2%); mean age was 16.63 years ± standard deviation (SD) 1.53, and 60.51% were female. MAP-PSI delivered mental health care to 932 youths compared with 16 under CUC and was associated with the prevention of 12,195 school absenteeism days, at an incremental cost of $7.84 USD per absenteeism day avoided. Based on model projections, the intervention reduced expected suicide attempts from 13 to four cases; corresponding to nine suicide attempts avoided at an estimated incremental cost of $10,622.10 USD per suicide attempt avoided. Sensitivity analyses suggested that lower intervention effectiveness substantially increased ICERs under conservative scenarios. 

Conclusions: The MAP-PSI is a cost-effective strategy for reducing suicidal behavior and school absenteeism in young people with depressive symptoms living in rural and Indigenous communities.