JMIR Publications

ABSTRACT

Background:

Childhood anxiety disorders are common and lead to substantial negative long-term outcomes in various life domains. Although digital interventions for preventing childhood anxiety problems have been increasingly used in the recent decade, there is limited evidence documenting their cost-effectiveness.

Objective:

The objective of our study was to evaluate the cost-effectiveness of a parent-led online cognitive behavioural therapy with therapist support (OSI+TS) alongside usual school practice, compared to usual school practice alone for children aged 4-7 years at risk of anxiety disorders identified through universal school screening.

Methods:

The economic evaluation was conducted alongside the MYCATS trial (N=865), a parallel group, superiority cluster randomised trial across 95 primary/infant schools in England. Schools were randomised (1:1) to OSI+TS or usual school practice, stratified by school-level deprivation. The primary analyses, at 12 months after randomisation, considered child quality-adjusted life years (QALYs) as the health economic outcome, using both the UK adult and the Australia adolescent value sets, and costs were from the National Health Service and Personal Social Service perspective. Incremental Cost-effectiveness Ratios (ICERs) were compared to the UK National Institute for Health and Care Excellence recommended threshold of £20,000-£30,000 per QALY gained. Sensitivity analyses included a societal perspective.

Results:

Children receiving OSI+TS gained 0.021 (95% CI 0.010 to 0.033 P<0.001) and 0.043 (95% CI 0.021 to 0.064 P<0.001) QALYs respectively for UK and Australian value sets, with an additional cost of £244.16 compared to school usual practice only, resulting in ICERs of £11,462.47 and £5,700.98, respectively. At the £20,000 threshold, OSI+TS had an 88.2% or 99.3% chance of being cost-effective.

Conclusions:

OSI+TS is cost-effective compared to usual school provision, supporting its future implementation for children at risk of anxiety problems. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN) 82398107