title: An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model.
abstract: Anxiety in children is highly frequent and causes severe dysfunction. Various studies have used screening procedures to identify high-anxious children and offer them indicated prevention, but the cost-effectiveness of these screening procedures in combination with a preventive intervention has never been examined. This study compared four potential strategies in relation to the prevention of child anxiety: (1) a one-time school-based screening which offers a child-focused intervention, (2) the screening and offering of a parent-focused intervention, (3) the screening and differentially offering a child- or parent-focused intervention, depending on whether or not the parents are anxious themselves, and (4) or doing nothing. An economic evaluation from a societal perspective (i.e. including direct healthcare costs, direct non-healthcare costs, indirect costs, and out-of-pocket costs), using a decision-analytic model. The model was based on the real-world 2-year participation rates of screening and intervention, and real-world costs and effects of high- and median-anxious children (aged 8-12) from regular primary schools. Incremental cost-effectiveness ratios were calculated, and several secondary and one-way sensitivity analyses were performed. The strategy of doing nothing and the strategy of screening and differentially offering the child- or parent-focused intervention, depending on parental anxiety levels were both worthwhile, with the latter strategy costing relatively little extra money compared to doing nothing. In conclusion, some evidence for the cost-effectiveness of screening and intervening was found. Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, were found to be the most cost-effective approach.
authors.affiliation: , Heerlen, Netherlands, ellin.simon@ou.nl.
authors.forename: Ellin
authors.initials: E
authors.lastname: Simon
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.forename: Susan M
authors.initials: SM
authors.lastname: Bögels
mesh_terms: D001007:Anxiety / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D002648:Child; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D010290:Parents / Q000523:psychology*; D012107:Research Design; D012574:Schools; D016896:Treatment Outcome
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