title: Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: a trial-based analysis.
abstract: BACKGROUND
  A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms. The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined.
  
  
  METHODS
  A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial (trial registration--ISRCTN 19083628) comparing classroom-based CBT with usual school provision of Personal Social and Health Education. Per-student cost of intervention was estimated from programme records. The study was undertaken in eight mixed-sex U.K. secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost-effectiveness analysis). The main outcome measures were individual self-reported data on care costs, Quality-Adjusted Life-Years (QALYs, based on the EQ-5D health-related quality-of-life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months.
  
  
  RESULTS
  Although there was lower quality-adjusted life-years over 12 months (-.05 QALYs per person, 95% confidence interval -.09 to -.005, p = .03) with CBT, this is a 'clinically' negligible difference, which was not found in the complete case analyses. There was little evidence of any between-arm differences in SMFQ scores (0.19, 95% CI -0.57 to 0.95, p = .62), or costs (£142, 95% CI -£132 to £415, p = .31) per person for CBT versus usual school provision.
  
  
  CONCLUSIONS
  Our analysis suggests that the universal provision of classroom-based CBT is unlikely to be either more effective or less costly than usual school provision.
authors.affiliation: PenTAG, University of Exeter Medical School, Exeter, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Anderson
authors.forename: Obioha C
authors.initials: OC
authors.lastname: Ukoumunne
authors.forename: Kapil
authors.initials: K
authors.lastname: Sayal
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Phillips
authors.forename: John A
authors.initials: JA
authors.lastname: Taylor
authors.forename: Melissa
authors.initials: M
authors.lastname: Spears
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Abigail
authors.initials: A
authors.lastname: Millings
authors.forename: Alan A
authors.initials: AA
authors.lastname: Montgomery
authors.forename: Paul
authors.initials: P
authors.lastname: Stallard
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006266:Health Education / Q000191:economics*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012572:School Health Services / Q000191:economics*; D012574:Schools
keywords: CBT; Depression prevention; adolescents; cognitive behavioural therapy; cost-effectiveness; schools