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.

Les programmes préventifs en milieu scolaire auprès des enfants et des adolescents présentant de l’anxiété

“…Les interventions donnent des résultats prometteurs, particulièrement l'approche cognitivo-comportementale (Kendall, 2012), mais il faut poursuivre les recherches en vue de déterminer quels enfants sont les plus susceptibles d'en tirer avantage, quels sont les ingrédients thérapeutiques actifs et quels sont les modérateurs et les média-teurs associés au changement (Rapee et al, 2009). Un autre aspect à considérer concerne l'efficience de ces interventions, c'est-à-dire quelle est l'intervention qui rapporte les plus grands bénéfices au moindre coût (Simon, Dirksen et Bögels, 2013;Simon, Dirksen, Bögels et Bodden, 2012). Les interventions universelles présentent l'avantage de ne pas stigmatiser les enfants et de toucher ceux dont la manifestation subtile des symptômes aurait pu échapper au dépistage.…”

Economic evaluations of interventions designed to prevent mental disorders: a systematic review

“…The review conducted by Mihalopoulos et al 7 was included because it contains results of cost-effectiveness evaluations for interventions designed to prevent childhood anxiety and psychosis that are not published elsewhere. To summarize the other nine studies, six aimed to prevent depression [12][13][14]16,18,19 (one of these is targeted post-partum depression 18 ), two aimed to prevent childhood anxiety, 17,20 and one aimed to prevent bulimia nervosa. 15 The majority of studies were of indicated type of interventions using therapies based on CBT (cognitive behavioural therapy) as the main intervention.…”

“…20 The others all expressed outcomes differently including scores of the Hospital Anxiety Depression Scale, 13 cases of post-partum depression averted using a clinical cutoff on the Edinburgh Postnatal Depression Scale, 18 and proportion of children not meeting diagnostic criteria on the Anxiety Disorders Interview Schedule (ADIS) for children. 17,20 Most articles were of good quality based on the CHEERS checklist. The studies that achieved good ratings tended to not meet the criterion of characterizing heterogeneity.…”

Effectiveness of a Cognitive Behavioral Therapy-Based Indicated Prevention Program for Children with Elevated Anxiety Levels: a Randomized Controlled Trial

“…The fourth important topic regarding the implementation of prevention programs is its cost-effectiveness. Screening and offering a child-focused intervention to children with elevated levels of anxiety was found to be more cost-effective compared to “doing nothing” and waiting, which implies waiting until symptoms grow into a full-blown disorder that requires mental health treatment (Simon et al 2013). Although the meta-analysis of Tuebert and Pinquart (2011) offered clear guidelines on how to increase the effectiveness of anxiety prevention, only few studies in their extensive review met most of these recommendations.…”