An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model

W. Simon*, Carmen D. Dirksen, Susan Maria Bögels

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    12 Citations (Web of Science)


    Anxiety in children is highly frequent and causes severe dysfunction. Various studies have used screening procedures to identify high-anxious children and offer them indicated prevention, but the cost-effectiveness of these screening procedures in combination with a preventive intervention has never been examined. This study compared four potential strategies in relation to the prevention of child anxiety: (1) a one-time school-based screening which offers a child-focused intervention, (2) the screening and offering of a parent-focused intervention, (3) the screening and differentially offering a child- or parent-focused intervention, depending on whether or not the parents are anxious themselves, and (4) or doing nothing. An economic evaluation from a societal perspective (i.e. including direct healthcare costs, direct non-healthcare costs, indirect costs, and out-of-pocket costs), using a decision-analytic model. The model was based on the real-world 2-year participation rates of screening and intervention, and real-world costs and effects of high- and median-anxious children (aged 8–12) from regular primary schools. Incremental cost-effectiveness ratios were calculated, and several secondary and one-way sensitivity analyses were performed. The strategy of doing nothing and the strategy of screening and differentially offering the child- or parent-focused intervention, depending on parental anxiety levels were both worthwhile, with the latter strategy costing relatively little extra money compared to doing nothing. In conclusion, some evidence for the cost-effectiveness of screening and intervening was found. Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, were found to be the most cost-effective approach.
    Original languageEnglish
    Pages (from-to)619-630
    Number of pages12
    JournalEuropean Child & Adolescent Psychiatry
    Early online date29 Mar 2013
    Publication statusPublished - Oct 2013


    • Anxiety
    • Prevention
    • Cost-effectiveness
    • Decision-analytic model
    • Intervention, screening


    Dive into the research topics of 'An explorative cost-effectiveness analysis of school-based screening for child anxiety using a decision analytic model'. Together they form a unique fingerprint.

    Cite this