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An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model

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Abstract

Anxiety in children is highly frequent and causes severe dysfunction. Various studies have used screening procedures to identify high-anxious children and offer them indicated prevention, but the cost-effectiveness of these screening procedures in combination with a preventive intervention has never been examined. This study compared four potential strategies in relation to the prevention of child anxiety: (1) a one-time school-based screening which offers a child-focused intervention, (2) the screening and offering of a parent-focused intervention, (3) the screening and differentially offering a child- or parent-focused intervention, depending on whether or not the parents are anxious themselves, and (4) or doing nothing. An economic evaluation from a societal perspective (i.e. including direct healthcare costs, direct non-healthcare costs, indirect costs, and out-of-pocket costs), using a decision-analytic model. The model was based on the real-world 2-year participation rates of screening and intervention, and real-world costs and effects of high- and median-anxious children (aged 8–12) from regular primary schools. Incremental cost-effectiveness ratios were calculated, and several secondary and one-way sensitivity analyses were performed. The strategy of doing nothing and the strategy of screening and differentially offering the child- or parent-focused intervention, depending on parental anxiety levels were both worthwhile, with the latter strategy costing relatively little extra money compared to doing nothing. In conclusion, some evidence for the cost-effectiveness of screening and intervening was found. Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, were found to be the most cost-effective approach.

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Acknowledgements:

The authors thank the participating children and their families. This study was supported by the Netherlands organisation for health research and development (ZonMW), Grant number: 22000138 to the third author.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Heerlen, Netherlands

    Ellin Simon, Carmen D. Dirksen & Susan M. Bögels

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  1. Ellin Simon
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  2. Carmen D. Dirksen
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  3. Susan M. Bögels
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Correspondence to Ellin Simon.

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Simon, E., Dirksen, C.D. & Bögels, S.M. An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model. Eur Child Adolesc Psychiatry 22, 619–630 (2013). https://doi.org/10.1007/s00787-013-0404-z

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  • DOI: https://doi.org/10.1007/s00787-013-0404-z

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