Cost-Effectiveness of a Mental Health Promotion Intervention “Feel Good with Culture and Nature”

Background

Common mental health problems place a substantial burden on healthcare systems, reduce productivity, and generate significant societal costs in Sweden. As a result, there is growing interest in alternative and complementary approaches that can support mental wellbeing. Nature- and culture-based interventions have shown promising effects in improving mental health outcomes but lack economic evaluations assessing their cost-effectiveness. The aim of this study was to conduct a cost-utility analysis (CUA) of the “Feel Good with Culture and Nature” (FGwNC) intervention implemented in primary care at Region Uppsala.

Methods

A cost-utility analysis from societal perspective was conducted using a before-after design with 25 participants referred from primary care. Health-related quality of life was measured using the Swedish version of Recovering Quality of Life questionnaire (ReQoL-10). Costs included healthcare, medication, and productivity losses. Missing data were managed using multiple imputation and uncertainty was assessed through non-parametric bootstrapping, deterministic sensitivity analyses.

Results

ReQoL-10 scores improved significantly (Δ = 3.17; p = 0.043; d = 0.43), while utility values showed a clinically meaningful but non-significant increase (Δ = 0.091; p = 0.076; d = 0. 38). Mean total societal costs decreased by €1,042 per participant (p = 0.627), driven by reductions in sick leave and unpaid work costs. The intervention was dominant from a societal perspective (67.7% probability of dominance). Results remained robust across all sensitivity analyses and scenario-based projections.

Conclusions

The FGwNC intervention appears cost-effective from a societal perspective, with cost savings driven by reduced productivity losses, supporting a future controlled trial with longer follow-up. Results must be interpreted with caution because of “before-and after” study design.

Key messages

• Complementary approaches can support mental well-being.

• Complementary approaches to improve mental health problem are cost-effective.