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Background <p>Owing 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.</p> Methods <p>The 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.</p> Results <p>In 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.</p> Conclusions <p>The 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.</p>

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Cost-utility analysis of school-based depression prevention interventions for Thai adolescents with subsyndromal depression

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  • 出版模式：

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  • 发表日期：

    2025年7月7日

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  • Lerdsak Rungmueanporn

摘要

Background

Owing 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.

Methods

The 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.

Results

In 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.

Conclusions

The 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.