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

Abstract

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.

Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system

“…47,[49][50][51][52][53][54][55][56][57] The economic evidence for such approaches was generally favourable, although there were exceptions. 52,55 Schools-based screening and prevention interventions were examined for anxiety, 58 depression, 47,53,62,63 eating disorders 52,59 and substance use disorders. 60 A UK RCT 61,62 and Australian modelling studies 47,53,63 came to diff erent conclusions about the potential cost-eff ectiveness of schoolsbased prevention strategies for depression, although challenges relating to acceptability and implementation of such strategies were highlighted in both contexts.…”

“…52,55 Schools-based screening and prevention interventions were examined for anxiety, 58 depression, 47,53,62,63 eating disorders 52,59 and substance use disorders. 60 A UK RCT 61,62 and Australian modelling studies 47,53,63 came to diff erent conclusions about the potential cost-eff ectiveness of schoolsbased prevention strategies for depression, although challenges relating to acceptability and implementation of such strategies were highlighted in both contexts. There was similarly mixed evidence for schools-based prevention strategies for eating disorders.…”

“…In general, there was supportive evidence for family-based interventions, although in several studies, individual therapy or self-help options were suggested to be more cost-eff ective alternatives. 66,68,69 A group delivery context (including in classrooms) was an att ribute of interventions for a range of mental health problems in nine studies, 47,52,58,[60][61][62][63]70,71 again with cost-eff ectiveness evidence that varied between populations. Other att ributes of interventions examined were automated processes, 63 case management, 48,50,65-67 crisis response, 51 fi nancing, 72 holistic care approaches, 48,58,72 information provision, 54,57,61,62,67,69,71 peer support and mentoring 57,71 and staff training and support 49 (Box 4).…”

The modeled cost‐effectiveness of family‐based and adolescent‐focused treatment for anorexia nervosa

“…Regardless of intervention type, parents were assumed to incur one hour of travel. Travel costs were based on a standardized weighted average cost of a trip to a health professional, similar to that reported in other mental health economic evaluations (Lee et al, ; Vos et al, 2010).…”

The cost‐effectiveness of cognitive behavioral therapy for bulimia nervosa in the Australian context

“…Given the insufficient evidence of individual heterogeneity of intervention outcomes, more complicated models (e.g., microsimulations) were considered unsuitable . Furthermore, this model has been used in other mental health cost-effectiveness studies (Le, Barendregt, Hay, Sawyer, Elizabeth, et al, 2017;Le, Barendregt, Hay, Sawyer, Paxton, et al, 2017;Lee, Y. et al, 2016). Annual transitions between health states were governed by epidemiological data including remission rates, adjusted mortality rates and relapse rates.…”