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Cited by 85Health Systems, Economic Evaluations, Quality of LifeMental Health Treatment and AccessSchool Health and Nursing Education

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

Open access
Lee, Y. Y., Barendregt, J. J., Stockings, E. A., Ferrari, A. J., Whiteford, H. A., Patton, G. A., Mihalopoulos, C.·2017·Epidemiology and Psychiatric Sciences
DOI 10.1017/s2045796016000469PMC PMC6998892
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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.

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Crossref · 10.1017/s2045796016000469

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  • Internet interventions meet adolescents' preference for self-reliance because they can be used at their own pace, at low costs, and independent of time and place.

    “Further, Internet interventions meet the preference of adolescents for self-reliance because they can use them at their own pace, at low costs, and independent of time and place [38, 48].”

    From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [48]

  • With respect to the prevention of depression in young people, the evidence is mixed; recent Australian modelled studies have shown that school-based psychological interventions were cost-effective regardless of whether they were universal or indicated interventions.

    “With respect to the prevention of depression in young people, the evidence is mixed; for example, recent Australian modelled studies have shown that school-based psychological interventions were costeffective regardless of whether they were universal or indicated interventions.”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [409]

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Authors
Lee, Y. Y., Barendregt, J. J., Stockings, E. A., Ferrari, A. J., Whiteford, H. A., Patton, G. A., & Mihalopoulos, C.
Affiliations
  • The University of Queensland (AU)
  • UNSW Sydney (AU)
  • Deakin University (AU)
Corresponding author
Lee, Y. Y.
ORCID
Venue
Epidemiology and Psychiatric Sciences
Publisher
Cambridge University Press (CUP)
Published
2016-08-11
Volume
26
Issue
5
Pages
545-564
ISSN
  • 2045-7960 (ISSN-L)
  • 2045-7979
DOI
10.1017/s2045796016000469
PMC
PMC6998892
OpenAlex
W2516395724
Cited by
85
References
57
Citations by year
2026: 2 · 2025: 10 · 2024: 11 · 2023: 9 · 2022: 14 · 2021: 15 · 2020: 7 · 2019: 6 · 2018: 5 · 2017: 6
FWCI
11.01
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • Epidemiology and Psychiatric Sciences (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
  • Figshare (submittedVersion, cc-by)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
Funders
  • Australian Government
  • National Health and Medical Research Council
  • National Medical Research Council
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Keywords
depression prevention, youth mental health, universal prevention, indicated prevention, school-based psychological intervention, cost-effectiveness, online intervention, face-to-face intervention, subthreshold depression, disability-adjusted life years, Markov model, Australia, primary and secondary schools, intervention effect size, depression incidence, health policy decision-making, New South Wales
MeSH terms
Adolescent, Australia, Child, Cost-Benefit Analysis, Depression, Major Depressive Disorder, Female, Humans, Primary Prevention, Outcome Assessment, Health Care

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