Cost-effectiveness of an intervention to prevent depression in at-risk teens.
BACKGROUND
Depression is common in adolescent offspring of depressed parents and can be prevented, but adoption of prevention programs is dependent on the balance of their incremental costs and benefits.


OBJECTIVE
To examine the incremental cost-effectiveness of a group cognitive behavioral intervention to prevent depression in adolescent offspring of depressed parents.


METHODS
Cost-effectiveness analysis of a recent randomized controlled trial.


METHODS
Kaiser Permanente Northwest, a large health maintenance organization.


METHODS
Teens 13 to 18 years old at risk for depression.


METHODS
Usual care (n = 49) or usual care plus a 15-session group cognitive therapy prevention program (n = 45).


METHODS
Clinical outcomes were converted to depression-free days and quality-adjusted life-years. Total health maintenance organization costs, costs of services received in other sectors, and family costs were combined with clinical outcomes in a cost-effectiveness analysis comparing the intervention with usual care for 1 year after the intervention.


RESULTS
Average cost of the intervention was $1632, and total direct and indirect costs increased by $610 in the intervention group. However, the result was not statistically significant, suggesting a possible cost offset. Estimated incremental cost per depression-free day in the base-case analysis was $10 (95% confidence interval, -$13 to $52) or $9275 per quality-adjusted life-year (95% confidence interval, -$12 148 to $45 641).


CONCLUSIONS
Societal cost-effectiveness of a brief prevention program to reduce the risk of depression in offspring of depressed parents is comparable to that of accepted depression treatments, and the program is cost-effective compared with other health interventions commonly covered in insurance contracts.
Lynch
Frances L
FL
Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1098, USA. frances.lynch@kp.org
Hornbrook
Mark
M
Clarke
Gregory N
GN
Perrin
Nancy
N
Polen
Michael R
MR
O'Connor
Elizabeth
E
Dickerson
John
J
D000293:Adolescent; D000367:Age Factors; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000517:prevention & control* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome