SEYLE – Saving and Empowering Young Lives in Europe

A cost effectiveness analysis of four arms of a school-based mental health intervention in Europe

Original presentation and abstract by Lee-Ann Burke, Helen Keeley and Paul Corcoran (Cork, Ireland), Danuta Wasserman and Vladimir Carli (Stockholm, Sweden), Judit Balazs (Budapest, Hungary), Julia Bobes and Pilar Saiz (Oviedo, Spain), Alan Apter (Tel-Aviv, Israel), Romuald Brunner (Heidelberg, Germany), Doina Cosman (Cluj-Napoca, Romania), Christian Haring (Innsbruck, Austria), Jean Pierre Kahn (Nancy, France), Dragan Marusic11 and Vita Postuvan (Koper, Slovenia), Airi Varik (Tallinn, Estonia) on the cost effectiveness of four arms of a school-based mental health intervention in Europe. This lecture was held at the ESCAP 2013 Congress in Dublin, Wednesday 10th July 2013.

SEYLE Project logo.Abstract
This study provides the results of a preliminary economic evaluation of the four suicide intervention arms of the Saving and Empowering Young Lives in Europe project. The interventions are as follows.
Arm 1: QPR, pupils are referred by school staff known as gatekeepers.
Arm 2: Awareness, students partake in role-plays to raise suicide awareness.
Arm 3: ProfScreen; pupils are screened by a professional clinical evaluator .
Arm 4: Minimal Intervention (control), posters are hung in the classrooms encouraging students to seek help by themselves if necessary.
The costs were collected after the interventions had taken place. The main outcome measure used in this analysis is the Beck Depression Inventory (BDI) which is divided into four categories; minimal, mild, moderate and severe. Health utilities are attached to each BDI health state and a quality adjusted life year (QALY) is calculated. An incremental cost effectiveness ratio (ICER) is provided for each intervention which gives the cost per QALY gained. Transition probabilities and Markov models are used in the estimation of the QALY and a sensitivity analysis is carried out to account for uncertainties in the collections data. In order to account for differing levels of QALYs between the four arms, the overall change in QALYs is measured. We can see, when controlling for heterogeneity in the baseline sample, that all arms are cost effective at a €40,000 per QALY threshold. However, the most cost effective intervention is ProfScreen at €190.00 per QALY. Without taking costs into consideration, the most effective arm in terms of improving quality of life is the ProfScreen arm with the largest change in QALYS from baseline to 3 month follow up being 0.0272. The Minimal arm displays the lowest change in QALYs. The high personnel costs involved in Arm 1: QPR and Arm 2: awareness may have caused a reduction in the cost effectiveness at €1,000.00 per QALY as measured by the BDI utilities. This report provided the results from a preliminary cost effectiveness analysis carried implemented in conjunction with four mental health interventions in schools in eleven countries across Europe as part of the SEYLE project. Both micro and macro costing techniques were employed and the costing data was collected retrospectively. To take into account baseline heterogeneity of the sample the overall change in the QALYs calculated using BDI utilities was calculated and it was seen that the biggest positive effect was seen in Arm 3: ProfScreen. When the costs are taken into consideration the most cost effective of the three arms when compared with Arm 4: minimal is Arm 3: ProfScreen. One way sensitivity analyses were carried out varying such parameters as BDI utilities and country costs, yet the results remained the same; Arm 3: ProfScreen remained the most cost-effective arm to improving mental health as measured by the Becks Depression Inventory.
Keywords: depression, cost, health outcomes, health utilities, Europe.

Presentation
View or download the full presentation here (pdf file, 18 slides).

Dr Lee Ann Burke: slide from her presentation.