Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trial
Introduction: Culturally adapted counselling (CAC) offers a potential solution by delivering culturally tailored early psychological support. However, its cost-effectiveness for reducing mental distress among EMs remains understudied, particularly in Asian settings. This study evaluated the cost-eff...
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Elsevier
2025-12-01
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| Series: | SSM - Mental Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666560325000970 |
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| author | Yi Nam Suen Yik Chun Wong Winnie Ng Shilpa Patwardhan Charlton Cheung Stephanie Ming Yin Wong Christy Lai Ming Hui Michael Tak Hing Wong Shalini Mahtani Eric Yu Hai Chen |
| author_facet | Yi Nam Suen Yik Chun Wong Winnie Ng Shilpa Patwardhan Charlton Cheung Stephanie Ming Yin Wong Christy Lai Ming Hui Michael Tak Hing Wong Shalini Mahtani Eric Yu Hai Chen |
| author_sort | Yi Nam Suen |
| collection | DOAJ |
| description | Introduction: Culturally adapted counselling (CAC) offers a potential solution by delivering culturally tailored early psychological support. However, its cost-effectiveness for reducing mental distress among EMs remains understudied, particularly in Asian settings. This study evaluated the cost-effectiveness of CAC compared to waitlist controls for low-income South Asian EMs experiencing mental distress in Hong Kong, using a healthcare perspective. Methods: This study conducted a trial-based cost-effectiveness analysis (CEA) alongside a randomized clinical trial. A total of 120 participants were randomized into CAC or waitlist groups, with CAC consisting of 6–10 culturally adapted counselling sessions. Costs, including intervention, other mental health service and administrative costs, were calculated using a microcosting approach. The primary outcome was quality-adjusted life years (QALYs), calculated over a 3-month period. Incremental cost-effectiveness ratios (ICERs) were estimated, and cost-effectiveness uncertainty was assessed using bootstrapped cost-effectiveness planes and acceptability curves. Results: CAC resulted reduced cost of other mental health service utilization (adjusted odds ratio [aOR] = 29.67, 95 %CI 23.10, 38.11; p < 0.001) but in greater intervention cost (aOR = 30.14, 95 %CI 23.28, 39.03; p < 0.001) and QALY gains compared to the waitlist group (aOR = 1.50, 95 %CI 1.31, 1,73; p < 0.001). The ICER is HKD 35,088 (USD 4470) per QALY, well below the willingness-to-pay threshold of HKD 385,800 (USD 49,150). Conclusions: CAC is a cost-effective early intervention for EMs experiencing mental distress. Policymakers should consider integrating CAC into community mental health services to address disparities. Future studies should assess long-term cost-effectiveness and strategies to improve male participation. |
| format | Article |
| id | doaj-art-1275e1552dc840cda0a3c9e89c2beb18 |
| institution | OA Journals |
| issn | 2666-5603 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Elsevier |
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| series | SSM - Mental Health |
| spelling | doaj-art-1275e1552dc840cda0a3c9e89c2beb182025-08-20T02:35:21ZengElsevierSSM - Mental Health2666-56032025-12-01810048510.1016/j.ssmmh.2025.100485Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trialYi Nam Suen0Yik Chun Wong1Winnie Ng2Shilpa Patwardhan3Charlton Cheung4Stephanie Ming Yin Wong5Christy Lai Ming Hui6Michael Tak Hing Wong7Shalini Mahtani8Eric Yu Hai Chen9School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Corresponding author. 5/F Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region of China.Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of ChinaThe Zubin Foundation, Hong Kong Special Administrative Region of ChinaThe Zubin Foundation, Hong Kong Special Administrative Region of ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of ChinaDepartment of Social Work and Social Adminstrations, Faculty of Social Sciences, University of Hong Kong, Hong Kong Special Administrative Region of ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of ChinaThe Zubin Foundation, Hong Kong Special Administrative Region of ChinaDepartment of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Orygen, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; Corresponding author. 2/F New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region of China.Introduction: Culturally adapted counselling (CAC) offers a potential solution by delivering culturally tailored early psychological support. However, its cost-effectiveness for reducing mental distress among EMs remains understudied, particularly in Asian settings. This study evaluated the cost-effectiveness of CAC compared to waitlist controls for low-income South Asian EMs experiencing mental distress in Hong Kong, using a healthcare perspective. Methods: This study conducted a trial-based cost-effectiveness analysis (CEA) alongside a randomized clinical trial. A total of 120 participants were randomized into CAC or waitlist groups, with CAC consisting of 6–10 culturally adapted counselling sessions. Costs, including intervention, other mental health service and administrative costs, were calculated using a microcosting approach. The primary outcome was quality-adjusted life years (QALYs), calculated over a 3-month period. Incremental cost-effectiveness ratios (ICERs) were estimated, and cost-effectiveness uncertainty was assessed using bootstrapped cost-effectiveness planes and acceptability curves. Results: CAC resulted reduced cost of other mental health service utilization (adjusted odds ratio [aOR] = 29.67, 95 %CI 23.10, 38.11; p < 0.001) but in greater intervention cost (aOR = 30.14, 95 %CI 23.28, 39.03; p < 0.001) and QALY gains compared to the waitlist group (aOR = 1.50, 95 %CI 1.31, 1,73; p < 0.001). The ICER is HKD 35,088 (USD 4470) per QALY, well below the willingness-to-pay threshold of HKD 385,800 (USD 49,150). Conclusions: CAC is a cost-effective early intervention for EMs experiencing mental distress. Policymakers should consider integrating CAC into community mental health services to address disparities. Future studies should assess long-term cost-effectiveness and strategies to improve male participation.http://www.sciencedirect.com/science/article/pii/S2666560325000970Cost-effectivenessCultural sensitivityEthnic minoritiesPreventativeMental healthIntervention |
| spellingShingle | Yi Nam Suen Yik Chun Wong Winnie Ng Shilpa Patwardhan Charlton Cheung Stephanie Ming Yin Wong Christy Lai Ming Hui Michael Tak Hing Wong Shalini Mahtani Eric Yu Hai Chen Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trial SSM - Mental Health Cost-effectiveness Cultural sensitivity Ethnic minorities Preventative Mental health Intervention |
| title | Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trial |
| title_full | Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trial |
| title_fullStr | Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trial |
| title_full_unstemmed | Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trial |
| title_short | Cost-effectiveness of culturally-adapted counselling mental distress in low-income ethnic minorities in Hong Kong: results based on a randomized clinical trial |
| title_sort | cost effectiveness of culturally adapted counselling mental distress in low income ethnic minorities in hong kong results based on a randomized clinical trial |
| topic | Cost-effectiveness Cultural sensitivity Ethnic minorities Preventative Mental health Intervention |
| url | http://www.sciencedirect.com/science/article/pii/S2666560325000970 |
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