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Young girl looking anxious

Researchers at Oxford Population Health’s Health Economics Research Centre are leading cost-effectiveness analyses for two trials aimed at improving screening and treatment for children with anxiety disorders.

More than a quarter of the population will experience an anxiety disorder at some point during their life and for half of these people this first occurs before the age of 11. The high prevalence and negative consequences associated with anxiety disorders also create substantial economic costs, emphasising the need for early effective identification and intervention.

The Child Anxiety Treatment in the context of COVID-19 (Co-CAT) trial will compare the clinical and cost-effectiveness of an online parent-led treatment for child anxiety problems with usual care delivered in Child and Adolescent Mental Health Services (CAMHS) in the UK throughout the COVID-19 pandemic to date.

Co-CAT is taking place in CAMHS across the NHS and local authorities in the UK, including third sector organisations that provide child mental health care on behalf of the NHS/local authorities. The study participants are children aged 5-12 years whose anxiety is the primary presenting problem (as determined by clinical teams), and their parents.

The economic evaluation of the trial will be conducted from both an NHS and societal perspective. It will use data collected during the trial through a combination of reports on the child’s health-related quality of life as reported by the parent, and the parent’s self-reported health-related quality of life, the Child Anxiety Impact Scale-parent report (CAIS-P), a therapist’s log of time spent on treatment delivery, child's school attendance, parental time off work and both the child’s and parent’s use of other health care resources. The reports will be completed at 14 and 26 weeks post-randomisation. The full Co-CAT protocol has been published in Trials.  

The Identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i) trial will establish if systematic screening for anxiety problems in children, sharing screening outcomes with families, and the delivery of a brief parent-led online intervention through schools is both effective and cost-effective.

iCATS-i2i will randomly divide participating schools into two groups, one of which will provide screening and intervention on top of usual school practice and the other will only receive support considered usual school practice. Each group will be balanced according to the level of deprivation within each school. In total, the trial will recruit 80 primary schools and 398 children (199 per group), aged eight-nine years, who screen positive for anxiety in a baseline assessment. The primary outcome of the trial will be the proportion of children who screen positive for anxiety problems at baseline who then screen negative for anxiety problems after 12 months.

The trial will include an economic evaluation to establish whether or not ‘screening and intervention’ is good value for money compared to usual school practice from an NHS and social care perspective. In addition, secondary analyses will take a societal perspective, acknowledging that the economic costs and consequences of mental health problems have wider impacts beyond the health and social care sectors.

The economic evaluation outcomes will be expressed as incremental costs per Quality-Adjusted Life Year (QALY) gained and incremental costs per child free from anxiety. The primary economic analysis will compare cost and consequences of each of the trial arms at 24-month follow-up, with an interim economic analysis at the 12-month follow-up in alignment with the clinical primary outcome. To explore the medium-term implications of ‘screening and intervention’, a secondary economic analysis will use modelling methods to extrapolate the trial results up to five and 10 years post-randomisation. The full iCATS-i2i protocol is published in Trials.

Dr Mara Violato, Associate Professor at Oxford Population Health’s Health Economics Research Centre, said ‘Identifying interventions for child anxiety problems that are both clinically effective and good value for money is of paramount importance given the high prevalence and the substantial long-lasting burden of anxiety disorders for the children themselves, their families, and the wider society. In the Co-CAT trial, delivering the treatment online in the context of CAMHS has the potential to increase access to families who may experience barriers to accessing traditional treatment approaches.

‘In the iCATS-i2i trial, if our procedures for ‘identification-to-intervention’ in the school context are found to be both clinically and cost-effective, we will have identified a viable way to improve access to early intervention for child anxiety problems, ameliorate their health-related quality of life, and reduce the associated economic burden. Our findings can also be used to inform future development and evaluation of systematic approaches to identifying children and adolescents with other mental health problems in primary and secondary school settings.’

The Co-CAT trial is funded by the Medical Research Council, part of UK Research and Innovation, and the National Institute for Health and Care Research (NIHR) Policy Research Programme. The iCATS-i2i trial is funded by the NIHR Programme Grant for Applied Research. 

The researchers are also undertaking a cost-effectiveness analysis of the Minimising Young Children’s Anxiety through Schools (MY-CATS) randomised trial.