The population cost-effectiveness of delivering universal and indicated school-based interventions to prevent the onset of major depression among youth in Australia

Lee, Y. Y., Barendregt, J. J., Stockings, E. A., Ferrari, A. J., Whiteford, H. A., Patton, G. A. and Mihalopoulos, C. (2016) The population cost-effectiveness of delivering universal and indicated school-based interventions to prevent the onset of major depression among youth in Australia. Epidemiology and Psychiatric Sciences, 26 5: 1-20. doi:10.1017/S2045796016000469


Author Lee, Y. Y.
Barendregt, J. J.
Stockings, E. A.
Ferrari, A. J.
Whiteford, H. A.
Patton, G. A.
Mihalopoulos, C.
Title The population cost-effectiveness of delivering universal and indicated school-based interventions to prevent the onset of major depression among youth in Australia
Journal name Epidemiology and Psychiatric Sciences   Check publisher's open access policy
ISSN 2045-7979
2045-7960
Publication date 2016-08-11
Year available 2017
Sub-type Article (original research)
DOI 10.1017/S2045796016000469
Open Access Status Not yet assessed
Volume 26
Issue 5
Start page 1
End page 20
Total pages 20
Place of publication Cambridge, United Kingdom
Publisher Cambridge University Press
Language eng
Subject 2713 Epidemiology
2739 Public Health, Environmental and Occupational Health
2738 Psychiatry and Mental health
Abstract Aims. School-based psychological interventions encompass: universal interventions targeting youth in the general population; and indicated interventions targeting youth with subthreshold depression. This study aimed to: (1) examine the population cost-effectiveness of delivering universal and indicated prevention interventions to youth in the population aged 11-17 years via primary and secondary schools in Australia; and (2) compare the comparative cost-effectiveness of delivering these interventions using face-to-face and internet-based delivery mechanisms.
Formatted abstract
Aims. School-based psychological interventions encompass: universal interventions targeting youth in the general population; and indicated interventions targeting youth with subthreshold depression. This study aimed to: (1) examine the population cost-effectiveness of delivering universal and indicated prevention interventions to youth in the population aged 11–17 years via primary and secondary schools in Australia; and (2) compare the comparative cost-effectiveness of delivering these interventions using face-to-face and internet-based delivery mechanisms.
Methods. We reviewed literature on the prevention of depression to identify all interventions targeting youth that would be suitable for implementation in Australia and had evidence of efficacy to support analysis. From this, we found evidence of effectiveness for the following intervention types: universal prevention involving group-based psychological interventions delivered to all participating school students; and indicated prevention involving group-based psychological interventions delivered to students with subthreshold depression. We constructed a Markov model to assess the cost-effectiveness of delivering universal and indicated interventions in the population relative to a ‘no intervention’ comparator over a 10-year time horizon. A disease model was used to simulate epidemiological transitions between three health states (i.e., healthy, diseased and dead). Intervention effect sizes were based on meta-analyses of randomised control trial data identified in the aforementioned review; while health benefits were measured as Disability-adjusted Life Years (DALYs) averted attributable to reductions in depression incidence. Net costs of delivering interventions were calculated using relevant Australian data. Uncertainty and sensitivity analyses were conducted to test model assumptions. Incremental cost-effectiveness ratios (ICERs) were measured in 2013 Australian dollars per DALY averted; with costs and benefits discounted at 3%.
Results. Universal and indicated psychological interventions delivered through face-to-face modalities had ICERs below a threshold of $50 000 per DALY averted. That is, $7350 per DALY averted (95% uncertainty interval (UI): dominates – 23 070) for universal prevention, and $19 550 per DALY averted (95% UI: 3081–56 713) for indicated prevention. Baseline ICERs were generally robust to changes in model assumptions. We conducted a sensitivity analysis which found that internet-delivered prevention interventions were highly cost-effective when assuming intervention effect sizes of 100 and 50% relative to effect sizes observed for face-to-face delivered interventions. These results should, however, be interpreted with caution due to the paucity of data.
Conclusions. School-based psychological interventions appear to be cost-effective. However, realising efficiency gains in the population is ultimately dependent on ensuring successful system-level implementation.
Keyword Adolescent
Child
Cost-effectiveness analysis
Depressive disorder
Economic evaluation
Major depression
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID APP1041131
APP1035887
APP 1019887
Institutional Status UQ
Additional Notes Published online 11 August 2016

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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