Review: Economic evidence of preventive interventions for anxiety disorders in children and adolescents – a systematic review

Abstract

Background: Anxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources. This review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents. Methods: A systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles. Results: The search yielded 1697 articles. Five articles were included in this review. Three were RCT-based, and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared with usual teaching. Selective parent training and indicative child-and parentfocused CBT prevention were likely cost-effective compared with usual care or doing nothing. Conclusion: Parent education and cognitive behaviour therapy interventions can be cautiously interpreted as being a costeffective way of preventing anxiety in children and adolescents. However, the evidence is weakly related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups. Key Practitioner Message• Anxiety disorders in children and adolescents can have long-term health effects. Furthermore, they have significant economic repercussions on families, healthcare providers, societies and nations. Prevention would be the preferred option, but very little is known about the cost-effectiveness of the different prevention strategies.• Decision makers need information about the economic evaluation of anxiety prevention to allocate scarce resources.• The evidence suggests that selective and indicated prevention such as parent education and cognitive behaviour therapy interventions are likely cost-effective. Universal prevention in anxiety is not costeffective use of limited resources. However, current empirical evidence on the cost-effectiveness of anxiety prevention programmes among children and adolescents is weak due to the paucity of studies, small sample sizes and short follow-up periods.

“Friendly, local and welcoming” – evaluation of a community mental health early intervention service

“…Youth mental health services in the UK have been cited as lacking in community-based services and preventative, early interventions (Vusio et al, 2021). A recent review has tentatively suggested parent training and early, preventative cognitive behavioural therapy (CBT) interventions could be cost-effective approaches to reduce anxiety related distress for young people (Anna-Kaisa et al, 2022). In addition, cross-service collaborations and early intervention models show promise (Tudor, 1996), as children and young people are often particularly vulnerable to environmental factors, such as parental addiction or unemployment (Coates, 2017).…”