Currently submitted to: Transfer Hub (manuscript eXchange)
Date Submitted: May 16, 2025
Open Peer Review Period: May 19, 2025 - Jul 14, 2025
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Cost-effectiveness of an online personalised parenting intervention to prevent affective disorders in high-risk adolescents compared to a standard educational package.
ABSTRACT
Background:
Adolescent depression has negative health and economic consequences both in the short and long term. Interventions aimed at improving parenting skills to prevent or reduce depressive symptoms in adolescents show promise, but there has been limited investigation of the cost-effectiveness of online parenting interventions.
Objective:
To estimate the economic costs, health-related quality of life outcomes and cost-effectiveness of an online personalised parenting intervention to prevent affective disorders in high-risk adolescents compared to a standard educational package.
Methods:
A cost-utility analysis was conducted based on data from a randomised controlled trial. The base-case analysis took the form of an intention-to-treat analysis conducted from a UK public sector perspective and separately from a societal perspective. Costs (£ 2022–2023 prices) were collected prospectively over a 15-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit of the personalised parenting intervention in comparison to the standard educational package. Pre-specified sensitivity analyses and subgroup analyses respectively explored uncertainty and heterogeneity surrounding cost-effectiveness estimates.
Results:
Participants (n=512) were randomised to the personalised parenting intervention (n=256) or the standard educational package (n=256). Mean (standard error) public sector costs over 15 months were estimated at £2,106 (£442) in the personalised parenting arm versus £1,909 (£388) in the standard educational package arm (mean difference: £197, p=0.740). Mean (standard deviation) observed QALY estimates were estimated at 0.84 (0.32) versus 0.82 (0.33), respectively (mean difference: 0.02, p=0.740). The base case (imputed) analysis generated an incremental cost of £639 (95%CI: £272 to £988) and incremental QALYs of 0.013 (95%CI: -0.021 to 0.042), indicating a 13%-27% probability of cost-effectiveness for the personalised parenting intervention, at cost-effectiveness thresholds of £20,000 and £30,000 per QALY. A sensitivity analysis, using observed data only (without imputation) generated an incremental cost of -£1,096 (95%CI: -£2,964 to £771) and incremental QALYs of 0.120 (95%CI: -0.053 to 0.293), but there was insufficient data to estimate probability of cost-effectiveness. The base-case cost-effectiveness results remained robust to other sensitivity analyses.
Conclusions:
This study found no evidence that an online parenting programme to prevent affective disorders in high risk adolescents was cost effective compared to a standard educational package. Clinical Trial: ISRCTN63358736
Citation
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