Cost-effectiveness of an Intervention to Prevent Depression in At-Risk Teens

CONTACT: Depression is common in adolescent offspring of depressed parents and can be prevented, but adoption of prevention programs is dependent on the balance of their incremental costs and benefits. OBJECTIVE: To examine the incremental cost-effectiveness of a group cognitive behavioral intervention to prevent depression in adolescent offspring of depressed parents. DESIGN: Cost-effectiveness analysis of a recent randomized controlled trial. SETTING: Kaiser Permanente Northwest, a large health maintenance organization. PARTICIPANTS: Teens 13 to 18 years old at risk for depression. INTERVENTIONS: Usual care (n = 49) or usual care plus a 15-session group cognitive therapy prevention program (n = 45). MAIN OUTCOME MEASURES: Clinical outcomes were converted to depression-free days and quality-adjusted life-years. Total health maintenance organization costs, costs of services received in other sectors, and family costs were combined with clinical outcomes in a cost-effectiveness analysis comparing the intervention with usual care for 1 year after the intervention. RESULTS: Average cost of the intervention was 1632, and total direct and indirect costs increased by 610 in the intervention group. However, the result was not statistically significant, suggesting a possible cost offset. Estimated incremental cost per depression-free day in the base-case analysis was 10 (95% confidence interval, -13 to 52) or 9275 per quality-adjusted life-year (95% confidence interval, -12 148 to 45 641). CONCLUSIONS: Societal cost-effectiveness of a brief prevention program to reduce the risk of depression in offspring of depressed parents is comparable to that of accepted depression treatments, and the program is cost-effective compared with other health interventions commonly covered in insurance contracts.