The population cost-effectiveness of interventions designed to prevent childhood depression.
OBJECTIVE
Depression in childhood and adolescence is common and often persists into adulthood. This study assessed the population-level cost-effectiveness of a preventive intervention that screens children and adolescents for symptoms of depression in schools and the subsequent provision of a psychological intervention to those showing elevated signs of depression. The target population for screening comprised 11- to 17-year-old children and adolescents in the 2003 Australian population.


METHODS
Economic modeling techniques were used to assess the incremental cost-effectiveness of the intervention compared with no intervention. The perspective was that of the health sector, and outcomes were measured by using disability-adjusted life-years (DALYs). Multivariate probabilistic and univariate sensitivity testing was applied to quantify variations in the model parameters.


RESULTS
The modeled psychological intervention had an incremental cost-effectiveness ratio of $5400 per DALY averted, with just 2% of iterations falling above a $50 000 per DALY value-for-money threshold. Results were robust to model assumptions.


CONCLUSIONS
After school screening, screening and the psychological intervention represent good value-for-money. Such an intervention needs to be seriously considered in any national package of preventive health services. Acceptability issues, particularly to intervention providers, including schools and mental health professionals, need to be considered before wide-scale adoption.
Deakin Health Economics, Deakin University, Melbourne, VIC 3125, Australia. cathy.mihalopoulos@deakin.edu.au
Cathrine
C
Mihalopoulos
Theo
T
Vos
Jane
J
Pirkis
Rob
R
Carter
D000293:Adolescent; D000704:Analysis of Variance; D001315:Australia; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics* / Q000517:prevention & control* / Q000628:therapy; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011315:Preventive Medicine / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D016896:Treatment Outcome