The Population Cost-effectiveness of Interventions Designed to Prevent Childhood Depression
The Population Cost-effectiveness of Interventions Designed to Prevent Childhood Depression
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DOI：
10.1542/peds.2011-1823
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发表时间：
2012-03-01
期刊：
影响因子：
8
通讯作者：
Carter, Rob
中科院分区：
文献类型：
--
作者：
Mihalopoulos, Cathrine;Vos, Theo;Carter, Rob
背景和目的：抑郁症在儿童和青少年时期很常见，并且经常持续到成年。本研究评估了一项预防性干预的成本效益，该干预在学校对儿童和青少年进行抑郁症状筛查，并随后对表现出抑郁症状加重的儿童和青少年进行心理干预。筛查的目标人群包括2003年澳大利亚人口中11至17岁的儿童和青少年。方法：使用经济建模技术来评估干预与不干预相比的增量成本效益。从卫生部门的角度出发，使用残疾调整生命年（DALYs）来衡量结果。采用多变量概率和单变量敏感性检验来量化模型参数的变化。结果：模拟心理干预的增量成本-效果比为每个DALY避免5400美元，只有2%的迭代低于每个DALY值-钱的阈值5万美元。结果对模型假设是稳健的。结论：学校后筛查、筛查和心理干预具有良好的物有所值。在任何国家一揽子预防性保健服务中，都需要认真考虑这种干预措施。在大规模采用之前，需要考虑可接受性问题，特别是对包括学校和精神卫生专业人员在内的干预提供者的可接受性问题。儿科2012;129: e723-e730
BACKGROUND AND OBJECTIVES: Depression in childhood and adolescence is common and often persists into adulthood. This study assessed the population-level cost-effectiveness of a preventive intervention that screens children and adolescents for symptoms of depression in schools and the subsequent provision of a psychological intervention to those showing elevated signs of depression. The target population for screening comprised 11- to 17-year-old children and adolescents in the 2003 Australian population.METHODS: Economic modeling techniques were used to assess the incremental cost-effectiveness of the intervention compared with no intervention. The perspective was that of the health sector, and outcomes were measured by using disability-adjusted life-years (DALYs). Multivariate probabilistic and univariate sensitivity testing was applied to quantify variations in the model parameters.RESULTS: The modeled psychological intervention had an incremental cost-effectiveness ratio of $5400 per DALY averted, with just 2% of iterations falling above a $50 000 per DALY value-for-money threshold. Results were robust to model assumptions.CONCLUSIONS: After school screening, screening and the psychological intervention represent good value-for-money. Such an intervention needs to be seriously considered in any national package of preventive health services. Acceptability issues, particularly to intervention providers, including schools and mental health professionals, need to be considered before wide-scale adoption. Pediatrics 2012; 129: e723-e730