Richard Ssegonja1, Filipa Sampaio2, Iman Alaie3, Anna Philipson4, Lars Hagberg4, Krahn Murray5, Anna Sarkadi6, Sophie Langenskiöld7, Ulf Jonsson8, Inna Feldman2. 1. Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden. Electronic address: richard.ssegonja@pubcare.uu.se. 2. Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden. 3. Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden. 4. University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 5. Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada. 6. Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden; Murdoch Children's Research Institute, Melbourne, Australia. 7. Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 8. Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
Abstract
BACKGROUND: Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. METHODS: A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option in a Swedish setting. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as differences in the proportion of cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. RESULTS: The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented a larger proportion of cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. LIMITATIONS: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. CONCLUSIONS: GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated.
BACKGROUND:Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. METHODS: A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option in a Swedish setting. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as differences in the proportion of cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. RESULTS: The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented a larger proportion of cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. LIMITATIONS: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. CONCLUSIONS:GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated.