Economic evaluation of mental health interventions among crisis‑affected populations: a systematic review

Populations affected by humanitarian crises experience high levels of mental health need, but the economic evidence available to guide implementation of mental health and psychosocial support (MHPSS) is limited. This systematic review assessed evidence on the cost-effectiveness of MHPSS interventions among crisis-affected populations. Medline, Embase, PsycInfo, EconLit and Global Health were searched for English-language primary studies published between 1 January 2000 and 31 May 2026. The search was initially conducted in July 2024 and updated on 11 June 2026. Full economic evaluations of interventions with an explicit MHPSS component among crisis-affected populations were eligible; partial economic evaluations and standalone modelling studies were excluded. Studies were double screened and findings synthesised narratively. Methodological quality and reporting standards were assessed using the modified BMJ Checklist and CHEERS 2022 Checklist. Risk of bias in the underlying effectiveness studies was not assessed separately. 12 studies involving 4,478 participants met the inclusion criteria. 11 evaluations were conducted alongside randomised controlled trials, nine included cost-utility analysis and nine were published from 2020 onwards. Six studies were conducted in high-income countries and six in LMICs, although only one was conducted in a low-income country. Eight studies reported findings interpreted by their authors as supporting cost-effectiveness or potential cost-effectiveness, but no intervention type was consistently superior. Five studies evaluated WHO-developed low-intensity interventions and all reported favourable cost-effectiveness findings. In three studies, economic findings were more favourable or conclusive using condition-specific outcomes than QALYs, while in three others inclusion of productivity losses strengthened the economic case for the intervention. Substantial variation in interventions, comparators, time horizons, perspectives, outcome measures and cost-effectiveness thresholds limited direct comparison between studies. Several forms of MHPSS may be cost-effective, but the limited evidence base prevents firm conclusions about which approaches offer the greatest value. Further economic evaluation is needed, particularly in LMICs, to support decisions about how limited resources for MHPSS can be used most effectively. The review received no external funding and was not registered.