Skip to main content
×
Home
    • Aa
    • Aa

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

  • Y. Y. Lee (a1) (a2), J. J. Barendregt (a1) (a3), E. A. Stockings (a4), A. J. Ferrari (a1) (a2) (a5), H. A. Whiteford (a1) (a2) (a5), G. A. Patton (a6) (a7) and C. Mihalopoulos (a8)...
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.

Copyright
Corresponding author
*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: y.lee5@uq.edu.au)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

R Anderson , OC Ukoumunne , K Sayal , R Phillips , JA Taylor , M Spears , R Araya , G Lewis , A Millings , AA Montgomery , P Stallard (2014). Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: a trial-based analysis. Journal of Child Psychology and Psychiatry 55, 13901397.

G Andersson , P Cuijpers , P Carlbring , H Riper , E Hedman (2014). Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 13, 288295.

G Andrews , N Titov (2010). Treating people you never see: internet-based treatment of the internalising mental disorders. Australian Health Review 34, 144147.

G Andrews , C Issakidis , K Sanderson , J Corry , H Lapsley (2004). Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. British Journal of Psychiatry 184, 526533.

JJ Barendregt , GJ Van Oortmarssen , T Vos , CJ Murray (2003). A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Population Health Metrics 1, 4.

A Baxter , A Page , H Whiteford (2011). Factors influencing risk of premature mortality in community cases of depression: a meta-analyitc review. Epidemiology Research International, 112.

R Burstein , T Fleming , J Haagsma , JA Salomon , T Vos , CJ Murray (2015). Estimating distributions of health state severity for the global burden of disease study. Population Health Metrics 13, 31.

AL Calear , H Christensen , A Mackinnon , KM Griffiths , R O'Kearney (2009). The YouthMood Project: a cluster randomized controlled trial of an online cognitive behavioral program with adolescents. Journal of Consulting and Clinical Psychology 77, 10211032.

R Carter , T Vos , M Moodie , M Haby , A Magnus , C Mihalopoulos (2008). Priority setting in health: origins, description and application of the Australian Assessing Cost-Effectiveness initiative. Expert Review of Pharmacoeconomics and Outcomes Research 8, 593617.

R Carter , M Moodie , A Markwick , A Magnus , T Vos , B Swinburn , MM Haby (2009). Assessing cost-effectiveness in obesity (ACE-obesity): an overview of the ACE approach, economic methods and cost results. BMC Public Health 9, 419.

H Christensen , KM Griffiths , L Farrer (2009). Adherence in internet interventions for anxiety and depression. Journal of Medical Internet Research 11, e13.

KL Dix , PT Slee , MJ Lawson , JP Keeves (2012). Implementation quality of whole-school mental health promotion and students’ academic performance. Child and Adolescent Mental Health 17, 4551.

SA Doi , JJ Barendregt , S Khan , L Thalib , GM Williams (2015). Advances in the meta-analysis of heterogeneous clinical trials II: the quality effects model. Contemporary Clinical Trials 45, 2329.

M Fazel , K Hoagwood , S Stephan , T Ford (2014 a). Mental health interventions in schools 1: mental health interventions in schools in high-income countries. Lancet Psychiatry 1, 377387.

AJ Ferrari , FJ Charlson , RE Norman , SB Patten , G Freedman , CJ Murray , T Vos , HA Whiteford (2013). Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Medicine 10, e1001547.

SS Han , B Weiss (2005). Sustainability of teacher implementation of school-based mental health programs. Journal of Abnormal Child Psychology 33, 665679.

AH Harris , SR Hill , G Chin , JJ Li , E Walkom (2008). The role of value for money in public insurance coverage decisions for drugs in Australia: a retrospective analysis 1994–2004. Medical Decision Making 28, 713722.

D Husereau , M Drummond , S Petrou , C Carswell , D Moher , D Greenberg , F Augustovski , AH Briggs , J Mauskopf , E Loder , CT Force (2013). Consolidated health economic evaluation reporting standards (CHEERS) statement. Value Health 16, e1e5.

AF Jorm (2014). Why hasn't the mental health of Australians improved? The need for a national prevention strategy. Australian New Zealand Journal of Psychiatry 48, 795801.

FL Lynch , M Hornbrook , GN Clarke , N Perrin , MR Polen , E O'Connor , J Dickerson (2005). Cost-effectiveness of an intervention to prevent depression in at-risk teens. Archives of General Psychiatry 62, 12411248.

SN Merry , SE Hetrick , GR Cox , T Brudevold-Iversen , JJ Bir , H McDowell (2011). Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews, CD003380.

C Mihalopoulos , ML Chatterton (2015). Economic evaluations of interventions designed to prevent mental disorders: a systematic review. Early Intervention in Psychiatry 9, 8592.

C Mihalopoulos , T Vos , J Pirkis , R Carter (2012). The population cost-effectiveness of interventions designed to prevent childhood depression. Pediatrics 129, e723e730.

C Mihalopoulos , R Carter , J Pirkis , T Vos (2013). Priority-setting for mental health services. Journal of Mental Health 22, 122134.

C Mihalopoulos , G Chen , A Iezzi , MA Khan , J Richardson (2014). Assessing outcomes for cost-utility analysis in depression: comparison of five multi-attribute utility instruments with two depression-specific outcome measures. British Journal of Psychiatry 205, 390397.

S Mohiuddin , K Payne (2014). Utility values for adults with unipolar depression: systematic review and meta-analysis. Medical Decision Making 34, 666685.

CJ Murray , T Vos , R Lozano , M Naghavi , AD Flaxman , C Michaud , M Ezzati , K Shibuya , JA Salomon , S Abdalla , V Aboyans , J Abraham , I Ackerman , R Aggarwal , SY Ahn , MK Ali , M Alvarado , HR Anderson , LM Anderson , KG Andrews , C Atkinson , LM Baddour , AN Bahalim , S Barker-Collo , LH Barrero , DH Bartels , MG Basanez , A Baxter , ML Bell , EJ Benjamin , D Bennett , E Bernabe , K Bhalla , B Bhandari , B Bikbov , A Bin Abdulhak , G Birbeck , JA Black , H Blencowe , JD Blore , F Blyth , I Bolliger , A Bonaventure , S Boufous , R Bourne , M Boussinesq , T Braithwaite , C Brayne , L Bridgett , S Brooker , P Brooks , TS Brugha , C Bryan-Hancock , C Bucello , R Buchbinder , G Buckle , CM Budke , M Burch , P Burney , R Burstein , B Calabria , B Campbell , CE Canter , H Carabin , J Carapetis , L Carmona , C Cella , F Charlson , H Chen , AT Cheng , D Chou , SS Chugh , LE Coffeng , SD Colan , S Colquhoun , KE Colson , J Condon , MD Connor , LT Cooper , M Corriere , M Cortinovis , KC de Vaccaro , W Couser , BC Cowie , MH Criqui , M Cross , KC Dabhadkar , M Dahiya , N Dahodwala , J Damsere-Derry , G Danaei , A Davis , D De Leo , L Degenhardt , R Dellavalle , A Delossantos , J Denenberg , S Derrett , DC Des Jarlais , SD Dharmaratne , M Dherani , C Diaz-Torne , H Dolk , ER Dorsey , T Driscoll , H Duber , B Ebel , K Edmond , A Elbaz , SE Ali , H Erskine , PJ Erwin , P Espindola , SE Ewoigbokhan , F Farzadfar , V Feigin , DT Felson , A Ferrari , CP Ferri , EM Fevre , MM Finucane , S Flaxman , L Flood , K Foreman , MH Forouzanfar , FG Fowkes , M Fransen , MK Freeman , BJ Gabbe , SE Gabriel , E Gakidou , HA Ganatra , B Garcia , F Gaspari , RF Gillum , G Gmel , D Gonzalez-Medina , R Gosselin , R Grainger , B Grant , J Groeger , F Guillemin , D Gunnell , R Gupta , J Haagsma , H Hagan , YA Halasa , W Hall , D Haring , JM Haro , JE Harrison , R Havmoeller , RJ Hay , H Higashi , C Hill , B Hoen , H Hoffman , PJ Hotez , D Hoy , JJ Huang , SE Ibeanusi , KH Jacobsen , SL James , D Jarvis , R Jasrasaria , S Jayaraman , N Johns , JB Jonas , G Karthikeyan , N Kassebaum , N Kawakami , A Keren , JP Khoo , CH King , LM Knowlton , O Kobusingye , A Koranteng , R Krishnamurthi , F Laden , R Lalloo , LL Laslett , T Lathlean , JL Leasher , YY Lee , J Leigh , D Levinson , SS Lim , E Limb , JK Lin , M Lipnick , SE Lipshultz , W Liu , M Loane , SL Ohno , R Lyons , J Mabweijano , MF MacIntyre , R Malekzadeh , L Mallinger , S Manivannan , W Marcenes , L March , DJ Margolis , GB Marks , R Marks , A Matsumori , R Matzopoulos , BM Mayosi , JH McAnulty , MM McDermott , N McGill , J McGrath , ME Medina-Mora , M Meltzer , GA Mensah , TR Merriman , AC Meyer , V Miglioli , M Miller , TR Miller , PB Mitchell , C Mock , AO Mocumbi , TE Moffitt , AA Mokdad , L Monasta , M Montico , M Moradi-Lakeh , A Moran , L Morawska , R Mori , ME Murdoch , MK Mwaniki , K Naidoo , MN Nair , L Naldi , KM Narayan , PK Nelson , RG Nelson , MC Nevitt , CR Newton , S Nolte , P Norman , R Norman , M O'Donnell , S O'Hanlon , C Olives , SB Omer , K Ortblad , R Osborne , D Ozgediz , A Page , B Pahari , JD Pandian , AP Rivero , SB Patten , N Pearce , RP Padilla , F Perez-Ruiz , N Perico , K Pesudovs , D Phillips , MR Phillips , K Pierce , S Pion , GV Polanczyk , S Polinder , CA Pope III, S Popova , E Porrini , F Pourmalek , M Prince , RL Pullan , KD Ramaiah , D Ranganathan , H Razavi , M Regan , JT Rehm , DB Rein , G Remuzzi , K Richardson , FP Rivara , T Roberts , C Robinson , FR De Leon , L Ronfani , R Room , LC Rosenfeld , L Rushton , RL Sacco , S Saha , U Sampson , L Sanchez-Riera , E Sanman , DC Schwebel , JG Scott , M Segui-Gomez , S Shahraz , DS Shepard , H Shin , R Shivakoti , D Singh , GM Singh , JA Singh , J Singleton , DA Sleet , K Sliwa , E Smith , JL Smith , NJ Stapelberg , A Steer , T Steiner , WA Stolk , LJ Stovner , C Sudfeld , S Syed , G Tamburlini , M Tavakkoli , HR Taylor , JA Taylor , WJ Taylor , B Thomas , WM Thomson , GD Thurston , IM Tleyjeh , M Tonelli , JA Towbin , T Truelsen , MK Tsilimbaris , C Ubeda , EA Undurraga , MJ van der Werf , J van Os , MS Vavilala , N Venketasubramanian , M Wang , W Wang , K Watt , DJ Weatherall , MA Weinstock , R Weintraub , MG Weisskopf , MM Weissman , RA White , H Whiteford , N Wiebe , ST Wiersma , JD Wilkinson , HC Williams , SR Williams , E Witt , F Wolfe , AD Woolf , S Wulf , PH Yeh , AK Zaidi , ZJ Zheng , D Zonies , AD Lopez , MA AlMazroa , ZA Memish (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 21972223.

B O'Dea , AL Calear , Y Perry (2015). Is e-health the answer to gaps in adolescent mental health service provision? Current Opinion in Psychiatry 28, 336342.

GC Patton , C Coffey , H Romaniuk , A Mackinnon , JB Carlin , L Degenhardt , CA Olsson , P Moran (2014). The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet 383, 14041411.

J Pirkis , I Hickie , L Young , J Burns , N Highet , T Davenport (2005). An evaluation of beyondblue, Australia's national depression initiative. International Journal of Mental Health Promotion 7, 3553.

RM Rapee , A Wignall , J Sheffield , N Kowalenko , A Davis , J McLoone , SH Spence (2006). Adolescents’ reactions to universal and indicated prevention programs for depression: perceived stigma and consumer satisfaction. Prevention Science 7, 167177.

JA Reyes-Portillo , L Mufson , LL Greenhill , MS Gould , PW Fisher , N Tarlow , MA Rynn (2014). Web-based interventions for youth internalizing problems: a systematic review. Journal of the American Academy of Child and Adolescent Psychiatry 53, 12541270 e5.

JA Salomon , JA Haagsma , A Davis , CM de Noordhout , S Polinder , AH Havelaar , A Cassini , B Devleesschauwer , M Kretzschmar , N Speybroeck , CJ Murray , T Vos (2015). Disability weights for the global burden of disease 2013 study. Lancet Global Health 3, e712e723.

T Slade , A Johnston , MA Oakley Browne , G Andrews , H Whiteford (2009). 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Australian New Zealand Journal of Psychiatry 43, 594605.

E Stockings , L Degenhardt , YY Lee , C Mihalopoulos , A Liu , M Hobbs , G Patton (2015). Symptom screening scales for detecting major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity and diagnostic utility. Journal of Affective Disorders 174, 447463.

A Thapar , S Collishaw , DS Pine , AK Thapar (2012). Depression in adolescence. Lancet 379, 10561067.

K van Zoonen , C Buntrock , DD Ebert , F Smit , CF Reynolds III, AT Beekman , P Cuijpers (2014). Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. International Journal of Epidemiology 43, 318329.

T Vos , MM Haby , JJ Barendregt , M Kruijshaar , J Corry , G Andrews (2004). The burden of major depression avoidable by longer-term treatment strategies. Archives of General Psychiatry 61, 10971103.

H Whiteford , M Harris , S Diminic (2013). Mental health service system improvement: translating evidence into policy. Australian New Zealand Journal of Psychiatry 47, 703706.

N Wong , L Kady , L Mewton , M Sunderland , G Andrews (2014). Preventing anxiety and depression in adolescents: a randomised controlled trial of two school based Internet-delivered cognitive behavioural therapy programmes. Internet Interventions 1, 9094.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Lee supplementary material
Appendix

 Word (433 KB)
433 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 16
Total number of PDF views: 154 *
Loading metrics...

Abstract views

Total abstract views: 666 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th September 2017. This data will be updated every 24 hours.