Abstract

A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms. The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined. A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial (trial registration--ISRCTN 19083628) comparing classroom-based CBT with usual school provision of Personal Social and Health Education. Per-student cost of intervention was estimated from programme records. The study was undertaken in eight mixed-sex U.K. secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost-effectiveness analysis). The main outcome measures were individual self-reported data on care costs, Quality-Adjusted Life-Years (QALYs, based on the EQ-5D health-related quality-of-life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months. Although there was lower quality-adjusted life-years over 12 months (-.05 QALYs per person, 95% confidence interval -.09 to -.005, p = .03) with CBT, this is a 'clinically' negligible difference, which was not found in the complete case analyses. There was little evidence of any between-arm differences in SMFQ scores (0.19, 95% CI -0.57 to 0.95, p = .62), or costs (£142, 95% CI -£132 to £415, p = .31) per person for CBT versus usual school provision. Our analysis suggests that the universal provision of classroom-based CBT is unlikely to be either more effective or less costly than usual school provision.

Highlights

  • Prevalence rates for depression in adolescents suggest that up to 5% may be affected and that it is associated with increased risk of suicide, social and educational impairment and mental health problems in adulthood (Thapar, Collishaw, Pine, & Thapar, 2012)

  • This paper presents the cost-effectiveness analysis from an NHS and social care perspective, of a randomised controlled trial (RCT) of a classroom-based Cognitive Behaviour Therapy (CBT) programme, the Resourceful Adolescent Programme (RAP) (Shochet & Ham, 2004)

  • We show results based on changes in our primary mental health outcome e and changes in quality-adjusted life-years

Read more

Summary

Introduction

Prevalence rates for depression in adolescents suggest that up to 5% may be affected and that it is associated with increased risk of suicide, social and educational impairment and mental health problems in adulthood (Thapar, Collishaw, Pine, & Thapar, 2012). Further details of the intervention, the design and conduct of the trial, and the effectiveness results for the high-risk adolescents are published elsewhere (Stallard et al, 2010; Stallard & Buck ., 2013; Stallard et al, 2012). The trial’s effectiveness results showed similar outcomes for high-risk adolescents in all three trial arms (see Box 1, below)(Stallard et al, 2012). This was a universally provided programme and it is important to investigate the effectiveness of the intervention for all trial participants and to explore data on treatment utilization and quality of life. We present the first estimation of the per student cost of such programmes, and a detailed breakdown of the health-related service use costs in a large school-based sample of 12-16 year olds

Objectives
Methods
Results
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call