LONGER-TERM COST-EFFECTIVENESS OF A COGNITIVE-BEHAVIORAL PROGRAM FOR PREVENTING DEPRESSION IN AT-RISK ADOLESCENTS

Purpose:

To evaluate long-term cost effectiveness of the “Prevention of depression in at-risk adolescents” (POD) randomized control trial from a societal perspective.

Method:

The POD trial was designed to establish clinical and cost effectiveness of a cognitive behavioral prevention program (CBP) compared to usual care (UC). Participants were assessed at baseline, 3, 9, 21, and 33 months post baseline. Depression-free-days (DFDs), the primary clinical outcome in the cost effectiveness analysis, were calculated from the Children’s Depression Rating Scale (CDRS). Cost data were collected concurrently through the Child and Adolescent Services Assessment (CASA), financial records, and interviews with study staff. The population studied was a community sample collected from four US sites of adolescents whose parent(s) had a history depression (N=316). Participants were 13-17 years old and had a prior depressive episode and/or current subsyndromal depressive symptoms.

Result:

Analyses were conducted on the 268 participants (85% of the sample) who had complete data. Total costs were not significantly different between groups (p=.437), although on average costs were higher in CBP (M=4,344, SD=23,435) than UC (M=2,910, SD=7,574). DFDs were significantly (p < .05) greater in CBP (M=882.1, SD=167.7) than UC (M=836.6, SD=198.5). Calculation of an incremental cost effectiveness ratio resulted in 31.55 dollars (2009 US) per additional DFD. Instrumentation to isolate the causal effects of participation in CBP on costs and outcomes is currently underway, as is multiple imputation of missing data.

Conclusion:

The CBP intervention was significantly better than UC with regard to the number of DFDs through the longer-term follow-up in this community sample of adolescents at high risk for depression. The primary clinical and cost effectiveness analyses of the POD trial, conducted with data through the nine month assessment, found strong clinical effects that were shown to be cost effective by widely accepted guidelines (Lynch et al., 2011). The longer-term incremental cost effectiveness ratio of DFDs is consistent with results of our short-term cost effectiveness analyses, supporting the sustainability of these effects. Thus, results from both the short- and longer-term analyses provide important information about the strength and durability of CBP in preventing depression in high-risk adolescents.