Doan Tran T, Hutton David W, Wright Davene R, Prosser Lisa A
Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora.
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.
JAMA Health Forum. 2025 May 2;6(5):e250711. doi: 10.1001/jamahealthforum.2025.0711.
Approximately one-fifth of adolescents in the US experience a major depressive episode each year. Universal depression screening for adolescents is recommended as part of routine pediatric primary care, but its cost-effectiveness is unclear.
To evaluate the cost-effectiveness of universal routine depression screening in adolescent primary care compared with usual care.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used a decision-analytic model with an embedded state-transition submodel and annual transitions. A hypothetical population of 1000 adolescents and young adults from ages 12 to 22 years, including 12 demographic groups of disaggregated combinations of sex (female and male) and race or ethnicity (American Indian or Alaska Native; Asian, Native Hawaiian, or Pacific Islander; Black or African American; Hispanic, Latino, or Spanish; White; and multiracial or other race or ethnicity) was simulated in pediatric primary care settings.
Universal depression screening of varying frequencies, including annual, biennial, and single-time screening at age 12 years, compared with usual care, defined as 20% annual screening rate.
Costs, health effects as measured by quality-adjusted life-years (QALYs) and depression-free days, and incremental cost-effectiveness ratios (ICERs) from the health care sector and limited societal perspectives.
A universal annual screening policy had an ICER of $66 822 per QALY or $84 per depression-free day gained compared with single-time screening from the limited societal perspective, including caregiver time costs. Universal single-time screening had an ICER of $44 483 per QALY and $62 per depression-free day gained compared with usual care. Targeted universal depression screening was more cost-effective for female individuals and those who identified as Hispanic, Latina, or Spanish, multiracial, or other race or ethnicity. Results were sensitive to treatment recovery rates, depression health state utility scores, treatment costs involving psychotherapy, suicide-related hospitalization costs, and initial depression prevalence at age 12 years. In approximately 99.8% of probabilistic simulations, universal annual screening had an ICER less than $150 000 per QALY threshold.
The study results suggest that universal annual depression screening for adolescents in primary care is cost-effective compared with a $100 000 per QALY willingness-to-pay threshold. Universal annual screening may be more cost-effective if health systems invest in efforts to enhance family access to telemedicine behavioral health, decrease treatment costs, or improve treatment effectiveness. Future analyses could examine whether additional potentially associated demographic factors, such as gender orientation, sexual identity, rurality, or comorbidities, affect cost-effectiveness outcomes.
美国每年约五分之一的青少年经历过一次重度抑郁发作。建议将青少年普遍抑郁症筛查作为儿科初级保健常规项目的一部分，但筛查的成本效益尚不清楚。
评估青少年初级保健中普遍常规抑郁症筛查与常规护理相比的成本效益。
设计、设置和参与者：这项经济评估使用了一个决策分析模型，该模型包含一个状态转换子模型和年度转换。在儿科初级保健环境中模拟了1000名年龄在12至22岁之间的青少年和年轻人的假设人群，包括12个人口统计学组，这些组是按性别（女性和男性）以及种族或族裔（美国印第安人或阿拉斯加原住民；亚裔、夏威夷原住民或太平洋岛民；黑人或非裔美国人；西班牙裔、拉丁裔或西班牙人；白人；以及多种族或其他种族或族裔）的不同组合划分的。
不同频率的普遍抑郁症筛查，包括每年、每两年以及12岁时单次筛查，与常规护理进行比较，常规护理定义为每年20%的筛查率。
成本、以质量调整生命年（QALYs）和无抑郁天数衡量的健康效果，以及从医疗保健部门和有限社会视角得出的增量成本效益比（ICERs）。
从有限社会视角（包括照顾者时间成本）来看，与单次筛查相比，普遍每年筛查政策每获得一个QALY的ICER为66822美元，或每增加一个无抑郁天数的ICER为84美元。与常规护理相比，普遍单次筛查每获得一个QALY的ICER为44483美元，每增加一个无抑郁天数的ICER为62美元。有针对性的普遍抑郁症筛查对女性个体以及那些认定为西班牙裔、拉丁裔或西班牙人、多种族或其他种族或族裔的人更具成本效益。结果对治疗康复率、抑郁健康状态效用评分、涉及心理治疗的治疗成本、与自杀相关的住院成本以及12岁时的初始抑郁患病率敏感。在大约99.8%的概率模拟中，普遍每年筛查的ICER低于每QALY阈值150000美元。
研究结果表明，与每QALY支付意愿阈值100000美元相比，在初级保健中对青少年进行普遍每年抑郁症筛查具有成本效益。如果卫生系统投资努力加强家庭获得远程医疗行为健康服务的机会、降低治疗成本或提高治疗效果，普遍每年筛查可能更具成本效益。未来的分析可以研究是否有其他潜在相关的人口统计学因素，如性取向、性身份、农村地区或合并症，会影响成本效益结果。
