title: The population cost-effectiveness of a parenting intervention designed to prevent anxiety disorders in children.
abstract: BACKGROUND
  Prevention and early intervention for anxiety disorders has lagged behind many other forms of mental disorder. Recent research has demonstrated the efficacy of a parent-focussed psycho-educational programme. The programme is directed at parents of inhibited preschool children and has been shown to reduce anxiety disorders at 1 and 3 years following intervention. The current study assesses the cost-effectiveness of this intervention to determine whether it could provide value-for-money across a population.
  
  
  METHODS
  A cost-utility economic framework, using Disability-Adjusted-Life-Years (DALYs) as the outcome, was adopted. Economic modelling techniques were used to assess the incremental cost-effectiveness ratio (ICER) of the intervention within the Australian population context, which was modelled as add-on to current practice. The perspective was the health sector. Uncertainty was measured using multivariate probabilistic testing and key assumptions were tested using univariate sensitivity analysis.
  
  
  RESULTS
  The median ICER for the intervention was AUD$8,000 per DALY averted with 99.8% of the uncertainty iterations falling below the threshold value-for-money criterion of AUD$50,000 per DALY averted. The results were robust to sensitivity testing.
  
  
  CONCLUSIONS
  Screening young children in a preschool setting for an inhibited temperament and providing a brief intervention to the parents of children with high levels of inhibition appears to provide very good value-for-money and worth considering in any package of preventive care. Further evaluation of this intervention under routine health service conditions will strengthen conclusions. Acceptability issues associated with this intervention, particularly to preschool staff and parents, need to be considered before wide-scale adoption is undertaken.
authors.affiliation: Deakin Health Economics, Deakin University, Melbourne, Vic., Australia.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Mihalopoulos
authors.affiliation: Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.affiliation: Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Rapee
authors.affiliation: Centre for Health Policy Programs and Economics, University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.affiliation: Deakin Health Economics, Deakin University, Melbourne, Vic., Australia.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Chatterton
authors.affiliation: Deakin Health Economics, Deakin University, Melbourne, Vic., Australia.
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Deakin Health Economics, Deakin University, Melbourne, Vic., Australia.
authors.forename: Rob
authors.initials: R
authors.lastname: Carter
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006266:Health Education; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D017063:Outcome Assessment, Health Care / Q000191:economics; D016487:Parenting / Q000523:psychology*; D010290:Parents / Q000193:education / Q000523:psychology; D011613:Psychotherapy / Q000191:economics*; D019057:Quality-Adjusted Life Years
keywords: Economic evaluation; anxiety disorders; children; prevention