Rungmueanporn Lerdsak
Child and Adolescent Mental Health Rajanagarindra Institute, Department of Mental Health, Ministry of Public Health, Bangkok, Thailand.
BMC Psychiatry. 2025 Jul 7;25(1):684. doi: 10.1186/s12888-025-06984-0.
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.
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.
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.
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.
由于青少年抑郁症的重大影响，预防性干预措施是必要的。在泰国，针对抑郁症的校内预防性干预措施侧重于识别和转介抑郁的青少年进行治疗。然而，对于预防亚综合征抑郁的青少年转变为完全临床抑郁症的重视有限。本研究旨在评估泰国校内抑郁症预防性干预措施的成本效益，为政策制定者提供见解。
该研究采用决策分析建模方法进行成本效益分析，将校内预防性干预措施与不干预进行比较。分析使用增量成本效益比来衡量结果，表明每避免一个额外的残疾调整生命年的成本。开发了一个马尔可夫模型来模拟疾病转变，使用一个假设的694,983名10岁学生的队列。该模型采用一年的时间周期、十年的时间范围、3%的贴现率和社会视角。参数根据相关数据进行估计。计算增量成本效益比，并与泰国每避免一个残疾调整生命年160,000泰铢的成本效益阈值进行比较。敏感性分析通过确定性和概率性方法解决不确定性，包括阈值分析。
在基础案例分析中，发现预防性干预措施优于不干预选项，每避免一个残疾调整生命年可节省15,630泰铢，与不干预相比是一个有利的选择。在确定性敏感性分析中，这一有利结果仍然稳健。阈值分析表明，每人每年的干预成本超过10,581泰铢会改变结果，使干预措施不再具有成本效益。此外，概率性敏感性分析表明，即使考虑到不确定性，干预措施具有成本效益的可能性为99%。
与不干预选项相比，针对青少年抑郁症的校内指示性预防计划极有可能是一种具有成本效益的干预措施。这一结论得到了其他使用建模方法的研究的类似结果的支持。
