The literature review for this thesis shows that economic evaluations of young people’s SRH programmes are scarce. The results of identified studies are largely incomparable, because the programmes and their contexts, research objectives and used evaluation methods are different, and due to a lack of transparency in documentation as well. The literature review process revealed that there are numerous publications on impact and effectiveness of young people’s SRH programmes. Yet, very few had any cost- or cost-effectiveness components. This is surprising, especially because financial constraints are one of the main bottlenecks of implementation of young people’s SRH programmes. Most of the impact-only studies measure behaviour intentions (knowledge, skills, attitude) or behaviour changes (abstinence, condom use, number of sex partners), which are much easier to obtain and less suitable for cost-effectiveness analyses than health outcomes (pregnancies, abortions, STIs and HIV infections). Most of the identified economic analyses are limited to only HIV infections (cost per averted HIV infection and/or cost per DALY). The choice is understandable because averted HIV infections create the highest cost savings.
The thesis makes the following suggestions for building an evidence base and improving comparability of economic evaluations of young people’s SRH programmes. First, efforts should be made to combine impact studies with economic evaluations. Second, more attention should be paid to the use of comparable methods and indicators in economic evaluations of SRH programmes. Third, results of economic evaluations should be compared. Fourth, documentation of methods, data and sources of economic evaluations of SRH programmes should be improved. Transparent reporting will improve comparability of the economic evaluations in the future.
Finally, the thesis makes the following general recommendations for economic evaluations of young people’s SRH programmes. Economic analyses should always aim to support decision making. These should be designed to answer questions that decision makers are dealing with, and analyses should focus only on issues that are relevant for policy making. Especially with young people’s SRH programmes health economists need to balance urgency for action (programme implementation) with long time required for collection of better data (impact and cost). In the low- and middle income country context, affordability is the primary and often the only economic criterion included in the decision making process. Therefore the sequence of questions that economic evaluations address should be: How much the programme cost? Does it create cost savings somewhere else? Is it cost-effective? Lastly, complex research results should be simplified and communicated to decision makers in their language.