The cost-effectiveness of delivering universal psychological interventions in schools to prevent depression among Australian adolescents: A model-based economic evaluation

Abstract Background Depression is highly prevalent among adolescents and adversely impacts health and social wellbeing. This study evaluated the cost-effectiveness of delivering a universal psychological intervention in schools to prevent depression among adolescent students. Method A Markov model was developed to evaluate the population cost-effectiveness of delivering universal school-based interventions to prevent depression among Australian students aged 11-17 years versus ‘no intervention’. The study involved: (1) a cost-utility analysis to estimate an incremental cost-effectiveness ratio (ICER) expressed as a cost per quality-adjusted life year (QALY); and (2) a return-on-investment (ROI) analysis to estimate a ROI ratio which divides total cost savings (due to health care cost savings and productivity gains) by total intervention costs. Costs, expressed in 2016 Australian dollars, and health impacts were both modelled over 10 years and discounted at 3% per year. Uncertainty and sensitivity analyses were conducted to test the robustness of input parameters/assumptions. Results Both analyses indicated that universal school-based interventions represent good value-for-money. The cost-utility analysis produced a dominant ICER (95% uncertainty interval [UI]: dominant–$57,605/QALY), indicating the intervention produced positive health benefits and net cost-savings. The ROI analysis produced an ROI ratio of 1.19 (95% UI: 0.33–3.87), indicating a return of A$1.19 per A$1 invested. Conclusion Universal school-based interventions can produce net cost-savings over the medium-to-long term and should be considered for widespread adoption across schools in Australia. The achievement of these net cost-savings will, however, depend on the realisation of productivity gains among parents/students.