Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: A trial-based analysis

Rob Anderson, Obioha C. Ukoumunne, Kapil Sayal, Rhiannon Phillips, John A. Taylor, Melissa Spears, Ricardo Araya, Glyn Lewis, Abigail Millings, Alan A. Montgomery, Paul Stallard

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1390-1397
Number of pages8
JournalJournal of Child Psychology and Psychiatry
Volume55
Issue number12
Early online date12 May 2014
DOIs
Publication statusPublished - 17 Nov 2014

Keywords

  • adolescents
  • CBT
  • cognitive behavioural therapy
  • cost-effectiveness
  • Depression prevention
  • schools

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    Anderson, R., Ukoumunne, O. C., Sayal, K., Phillips, R., Taylor, J. A., Spears, M., Araya, R., Lewis, G., Millings, A., Montgomery, A. A., & Stallard, P. (2014). Cost-effectiveness of classroom-based cognitive behaviour therapy in reducing symptoms of depression in adolescents: A trial-based analysis. Journal of Child Psychology and Psychiatry, 55(12), 1390-1397. https://doi.org/10.1111/jcpp.12248