Cost-effectiveness of child-focused and parent-focused interventions in a child anxiety prevention program

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Abstract

In this study, the cost-effectiveness of three indicated anxiety prevention strategies was examined from a societal perspective. Children (aged 8–12) were recruited via primary schools, selecting children scoring as high-anxious on an anxiety screening questionnaire. Participating children and their parents were randomized to a child – a parent-focused, or non-intervention group. All groups completed a diagnostic interview and standardized cost-diaries at pretest, and 1- and 2-year follow-up. Incremental cost-effectiveness ratios per ‘ADIS improved’ child (based on diagnostic information) were calculated and cost-effectiveness acceptability curves and frontiers were plotted. The base-case and most secondary analyses showed it would be cost-effective to offer high-anxious children an intervention, and the parent-focused intervention to be the optimal strategy at lower monetary threshold values than the child-focused intervention and when parents were anxious. The child-focused intervention was dominant when analyses were performed from a healthcare perspective, for boys, and for children of grades 7–8 of primary school.

Highlights

► Offering high-anxious children (8–12 years) preventive interventions is cost-effective. ► Parent-focused intervention cost-effective with anxious parent and at low threshold. ► Child-focused intervention cost-effective for oldest children and boys. ► Child-focused intervention cost-effective from healthcare perspective.

Section snippets

Design and participants

Children, aged 8–12, and their parents were recruited for an RCT on the prevention of anxiety disorders via primary schools (grades 5–8) in the Netherlands. Children completed the Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71, Bodden, Bögels, & Muris, 2009) at school. If they scored in the top-15% (i.e. high-anxious), children and their parents were asked to enroll in the RCT. They were consequently randomized to either CI, PI, or NI.

At pretest (maximum 3 months after

Participants

To test whether participants of the economic evaluation (i.e. those that completed both the ADIS and cost-diary at pretest) differed from participants of the entire RCT, these participants were compared on anxiety difficulties (ADIS sum of severities) at pretest and on child's age, child's sex, Dutch ethnicity, parental educational level, and parental current unemployment. Pretest's anxiety disorders’ sum of severity scores was not significantly different between participants that completed the

Main results

The uncorrected costs differed between groups at pretest and pretest costs were predictive of costs at 1- and 2-year follow-up. To correct for overestimation of pretest differences, regression corrections were applied and the base-case and secondary analyses were based on the corrected costs. The total corrected societal costs were somewhat higher in CI than in PI and NI, mainly due to higher direct non-healthcare costs. Nevertheless, groups did not differ significantly on (sub)total societal

Acknowledgements

The authors thank the participating children and their families. This study was supported by: Zorg onderzoek Nederland-MW (ZonMW), grant number: 22000138 to the third author (SB).

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