1. Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: a trial-based analysis.
- Author
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Anderson, Rob, Ukoumunne, Obioha C., Sayal, Kapil, Phillips, Rhiannon, Taylor, John A., Spears, Melissa, Araya, Ricardo, Lewis, Glyn, Millings, Abigail, Montgomery, Alan A., and Stallard, Paul
- Subjects
THERAPEUTICS ,COGNITIVE therapy ,CONFIDENCE intervals ,COST effectiveness ,MENTAL depression ,HIGH schools ,LONGITUDINAL method ,HEALTH outcome assessment ,QUALITY of life ,QUESTIONNAIRES ,REGRESSION analysis ,RESEARCH funding ,SELF-evaluation ,SAMPLE size (Statistics) ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,DISEASE prevalence ,QUALITY-adjusted life years ,DATA analysis software ,DESCRIPTIVE statistics ,ADOLESCENCE - Abstract
Background 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. Methods 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 UK 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. Results 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. Conclusions 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. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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