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Clinical Child Psychology and Psychiatry
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Costs and Cost-Effectiveness of Family CBT Versus Individual CBT in Clinically Anxious Children

Denise H.M. Bodden

University of Utrecht, The Netherlands, d.bodden{at}uu.nl

Carmen D. Dirksen

University Hospital Maastricht, The Netherlands

Susan M. Bögels

University of Amsterdam, The Netherlands

Maaike H. Nauta

University Medical Center Groningen, The Netherlands

Else De Haan

Academic Medical Centre, De Bascule, The Netherlands

Jaap Ringrose

Mental Health Care, De Stroom, The Netherlands

Carla Appelboom

Mental Health Care Youth Department, Groningen-South, The Netherlands

Andries G. Brinkman

Mental Health Care, Child and Adolescent Psychiatry, Eindhoven, The Netherlands

Karen C.M.M.J. Appelboom-Geerts

Reinier van Arkelgroep, Herlaarhof, The Netherlands

The objective of this study was to investigate the cost-effectiveness of family cognitive-behavioral therapy (CBT) compared with individual CBT in children with anxiety disorders. Clinically anxious children (aged 8—18 years) referred for treatment were randomly assigned to family or individual CBT and were assessed pre-treatment, post treatment, and at 3 months and 1 year after treatment. Cost-effectiveness ratios were calculated expressing the incremental costs per anxiety-free child and the incremental costs per Quality Adjusted Life Year (QALY) for the referred child. Neither societal costs nor effectiveness were significantly different between individual and family CBT. However, the point estimates of the cost-effectiveness ratios resulted in dominance for individual CBT, indicating that individual CBT is more effective and less costly than family CBT. These results were confirmed by bootstrap analyses and cost-effectiveness acceptability curves. Several secondary and sensitivity analyses showed that the results were robust. It can be concluded that family CBT is not a cost-effective treatment for clinically anxious children, compared with individual CBT.

Key Words: anxiety disorders • children • cost-effectiveness • costs

Clinical Child Psychology and Psychiatry, Vol. 13, No. 4, 543-564 (2008)
DOI: 10.1177/1359104508090602
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