ArticleBMC psychiatry2025
Cost-utility analysis of school-based depression prevention interventions for Thai adolescents with subsyndromal depression.
Article in BMC psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOwing to the substantial impact of adolescent depression, preventive interventions are necessary. In Thailand, the school-based preventive intervention for depression focuses on the identification and referral of depressed adolescents for treatment. However, there is a limited emphasis on preventing subsyndromal depressed youths from transitioning to full clinical depression. This study aims to assess the cost-effectiveness of school-based preventive interventions for depression in Thailand, providing insights for policymakers.
methodsThe study employed a decision analytic modeling approach for a cost-utility analysis, comparing school-based preventive interventions to no intervention. The analysis used the incremental cost-effectiveness ratio to measure outcomes, indicating the cost per additional disability-adjusted life year averted. A Markov model was developed to simulate the disease transition, using a hypothetical cohort of 694,983 students starting at the age of 10. The model used a one-year time cycle, a ten-year time horizon, a 3% discount rate and a societal perspective. Parameters were estimated from relevant data. The incremental cost-effectiveness ratio was calculated and compared against Thailand's cost-effectiveness threshold of 160,000 Baht/DALY averted. Sensitivity analyses addressed uncertainties through deterministic and probabilistic approaches, including threshold analysis.
resultsIn the base case analysis, the preventive intervention was found to dominate the no-intervention option, with a cost saving of 15,630 Baht per DALY averted, making it a favorable option compared with no-intervention. This favorable outcome remained robust in deterministic sensitivity analyses. A threshold analysis revealed that an annual intervention cost exceeding 10,581 Baht per person would shift the result, rendering the intervention no longer cost-effective. Additionally, the probabilistic sensitivity analysis indicated a 99% likelihood of the intervention being cost-effective, even when accounting for uncertainties.
conclusionsThe school-based indicated prevention program for depression in adolescents is highly likely to be a cost-effective intervention compared with no-intervention option. This conclusion is supported by similar findings from other studies that used a modelling approach.
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