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The population cost-effectiveness of delivering universal and indicated school-based interventions to prevent the onset of major depression among youth in Australia

Published online by Cambridge University Press:  11 August 2016

Y. Y. Lee Open the ORCID record for Y. Y. Lee [Opens in a new window] ,
J. J. Barendregt ,
E. A. Stockings Open the ORCID record for E. A. Stockings [Opens in a new window] ,
A. J. Ferrari ,
H. A. Whiteford ,
G. A. Patton  and
C. Mihalopoulos
Y. Y. Lee*
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia
J. J. Barendregt
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Epigear International Pty Ltd, Sunrise Beach, Queensland, Australia
E. A. Stockings
Affiliation:
National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia
A. J. Ferrari
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, USA
H. A. Whiteford
Affiliation:
School of Public Health, The University of Queensland, Herston, Queensland, Australia Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, USA
G. A. Patton
Affiliation:
Centre for Adolescent Health, Murdoch Children's Research Institute (MCRI), Royal Children's Hospital, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
C. Mihalopoulos
Affiliation:
Deakin Health Economics, Population Health Strategic Research Centre, Deakin University, Burwood, Victoria, Australia
*
*Address for correspondence: Y. Y. Lee, MHEcon(Adv). Queensland Centre for Mental Health Research, The Park – Centre for Mental Health, Locked Bag 500, Sumner Park BC, QLD 4074, Australia. (Email: [email protected])
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Abstract

Aims.

School-based psychological interventions encompass: universal interventions targeting youth in the general population; and indicated interventions targeting youth with subthreshold depression. This study aimed to: (1) examine the population cost-effectiveness of delivering universal and indicated prevention interventions to youth in the population aged 11–17 years via primary and secondary schools in Australia; and (2) compare the comparative cost-effectiveness of delivering these interventions using face-to-face and internet-based delivery mechanisms.

Methods.

We reviewed literature on the prevention of depression to identify all interventions targeting youth that would be suitable for implementation in Australia and had evidence of efficacy to support analysis. From this, we found evidence of effectiveness for the following intervention types: universal prevention involving group-based psychological interventions delivered to all participating school students; and indicated prevention involving group-based psychological interventions delivered to students with subthreshold depression. We constructed a Markov model to assess the cost-effectiveness of delivering universal and indicated interventions in the population relative to a ‘no intervention’ comparator over a 10-year time horizon. A disease model was used to simulate epidemiological transitions between three health states (i.e., healthy, diseased and dead). Intervention effect sizes were based on meta-analyses of randomised control trial data identified in the aforementioned review; while health benefits were measured as Disability-adjusted Life Years (DALYs) averted attributable to reductions in depression incidence. Net costs of delivering interventions were calculated using relevant Australian data. Uncertainty and sensitivity analyses were conducted to test model assumptions. Incremental cost-effectiveness ratios (ICERs) were measured in 2013 Australian dollars per DALY averted; with costs and benefits discounted at 3%.

Results.

Universal and indicated psychological interventions delivered through face-to-face modalities had ICERs below a threshold of $50 000 per DALY averted. That is, $7350 per DALY averted (95% uncertainty interval (UI): dominates – 23 070) for universal prevention, and $19 550 per DALY averted (95% UI: 3081–56 713) for indicated prevention. Baseline ICERs were generally robust to changes in model assumptions. We conducted a sensitivity analysis which found that internet-delivered prevention interventions were highly cost-effective when assuming intervention effect sizes of 100 and 50% relative to effect sizes observed for face-to-face delivered interventions. These results should, however, be interpreted with caution due to the paucity of data.

Conclusions.

School-based psychological interventions appear to be cost-effective. However, realising efficiency gains in the population is ultimately dependent on ensuring successful system-level implementation.

Keywords

Adolescentchildcost-effectiveness analysisdepressive disordereconomic evaluationmajor depressionprimary prevention
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 5 , October 2017 , pp. 545 - 564
Copyright
Copyright © Cambridge University Press 2016 

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