Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems

Abstract

BackgroundThe increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health is widespread. Dance is a popular form of exercise that could be a protective factor in preventing and treating symptoms of depression. The aim of this study was to assess the cost-effectiveness of a dance intervention in addition to usual school health services for adolescent girls with internalizing problems, compared with usual school health services alone.MethodsA cost-utility analysis from a societal perspective based on a randomized controlled intervention trial was performed. The setting was a city in central Sweden with a population of 130 000. A total of 112 adolescent girls, 13–18 years old, with internalizing problems participated in the study. They were randomly assigned to intervention (n = 59) or control (n = 53) group. The intervention comprised dance twice weekly during eight months in addition to usual school health services. Costs for the stakeholder of the intervention, treatment effect and healthcare costs were considered. Gained quality-adjusted life-years (QALYs) were used to measure the effects. Quality of life was measured with the Health Utility Index Mark 3. Cost-effectiveness ratios were based on the changes in QALYs and net costs for the intervention group compared with the control group. Likelihood of cost-effectiveness was calculated.ResultsAt 20 months, quality of life had increased by 0.08 units more in the intervention group than in the control group (P = .04), translating to 0.10 gained QALYs. The incremental cost-effectiveness ratio was USD $3,830 per QALY and the likelihood of cost-effectiveness was 95%.ConclusionsIntervention with dance twice weekly in addition to usual school health services may be considered cost-effective compared with usual school health services alone, for adolescent girls with internalizing problems.Trial registrationName of the trial registry: “Influencing Adolescent Girls’ With Creative Dance Twice Weekly”Trial registration number: NCT01523561

The effects of a dance intervention on somatic symptoms and emotional distress in adolescent girls: A randomized controlled trial

“…Group dance is a social type of physical activity popular with young women. 17 It can be cost effective 18 and is a potentially useful way of positively influencing physical health outcomes 19 and psychological well-being, 20 and increasing self-trust, self-esteem and self-expression in adolescents. 21 There is a need to improve the relatively low self-perceptions of adolescent girls and to reduce the risk of them developing negative ideas about their bodies.…”

Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system

“…47,[49][50][51][52][53][54][55][56][57] The economic evidence for such approaches was generally favourable, although there were exceptions. 52,55 Schools-based screening and prevention interventions were examined for anxiety, 58 depression, 47,53,62,63 eating disorders 52,59 and substance use disorders. 60 A UK RCT 61,62 and Australian modelling studies 47,53,63 came to diff erent conclusions about the potential cost-eff ectiveness of schoolsbased prevention strategies for depression, although challenges relating to acceptability and implementation of such strategies were highlighted in both contexts.…”

“…In general, there was supportive evidence for family-based interventions, although in several studies, individual therapy or self-help options were suggested to be more cost-eff ective alternatives. 66,68,69 A group delivery context (including in classrooms) was an att ribute of interventions for a range of mental health problems in nine studies, 47,52,58,[60][61][62][63]70,71 again with cost-eff ectiveness evidence that varied between populations. Other att ributes of interventions examined were automated processes, 63 case management, 48,50,65-67 crisis response, 51 fi nancing, 72 holistic care approaches, 48,58,72 information provision, 54,57,61,62,67,69,71 peer support and mentoring 57,71 and staff training and support 49 (Box 4).…”

Exploring experiences among adopters during the diffusion of a novel dance intervention in Sweden

“…In the extensive framework and review conducted by Durlak and DuPre (2008), the perceived need for an innovation as well as perceived benefits of the innovation desired at the local level were found to be consistently related to positive implementation results. Further, the informants expressed that the expected benefits of the innovation came at a relatively low cost, with the perceived promise of rapid results for the target group (Philipsson et al, 2013). This perception explains the interest in the innovation.…”

“…In a qualitative study, girls who had participated in the dance intervention expressed that the intervention had given them a feeling of being free, and increased self-trust and confidence (Duberg, Möller, & Sunvisson, 2016). The dance intervention, organized as a complement to the school health services, was demonstrated to be cost-effective compared with usual school health services alone (Philipsson, Duberg, Möller, & Hagberg, 2013). …”