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Economic Evaluation of an Intervention Designed to Reduce Bullying in Australian Schools



There is a shortage of information on the costs and benefits of anti-bullying programs implemented in Australia. Information on the costs and benefits of anti-bullying programs is vital to assist policy making regarding the adoption of these programs. The aim of this study was to estimate the changes to costs and health benefits of implementing the “Friendly Schools Friendly Families” (FSFF) anti-bullying intervention in Australia.


A societal perspective cost-effectiveness analysis was undertaken based on randomised controlled trial data for an anti-bullying intervention implemented in primary schools in Western Australia. The modelling strategy addressed changes to costs comprising intervention costs, less cost-savings, and then changes to health benefits measured by avoidable disability-adjusted life years (DALYs). Costs and health benefits were identified, measured, and valued in 2016 Australian dollars. Intermediate events modelled included anxiety disorders, depressive disorders, intentional self-harm, cost-savings accrued by educator time, and reduced productivity losses for carers associated with absenteeism. Uncertainty analysis and scenario analyses were also conducted.


The prevalence of bullying victimisation was reduced by 18% by the Friendly Schools Friendly Families anti-bullying intervention. At a national level, this is expected to result in the avoidance of 9114 DALYs (95% CI 8770–9459) and cost-savings of A$120 million per year. The majority of cost-savings were associated with the reduction in mental healthcare. The model results demonstrated that the FSFF anti-bullying intervention is likely to be a cost-effective approach to reduce bullying in Australia, relative to a threshold of A$50,000 per DALY averted, with an ICER of A$1646.


The Friendly Schools Friendly Families anti-bullying intervention represents a good investment compared to usual activities for the management of child and adolescent bullying in Australia. The investment and implementation of evidence-based interventions that reduce bullying victimisation and bullying perpetration in schools could reduce the economic burden associated with common mental health disorders and thereby improve the health of many Australians.

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This research is part of Amarzaya Jadambaa’s PhD project, which is funded by a Queensland University of Technology Postgraduate Research Award (QUTPRA) and a Faculty Write Up Scholarship, QUT. James Scott was supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship Grant #1105807 for prevention of youth mental illness. Donna Cross was supported by a NHMRC Research Fellowship Grant #1119339.The funders had no role in the design of the study and data collection, analysis and interpretation of results, and in writing the manuscript or submitting it for publication. The authors wish to thank Erin Erceg and Melanie Epstein, of Telethon Kids Institute, for assistance in acquisition of cost data and Prof. Elizabeth Geelhoed, of the University of Western Australia, for reviewing the manuscript from an economic evaluation perspective.

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Correspondence to Amarzaya Jadambaa.

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Amarzaya Jadambaa, Nicholas Graves, Donna Cross, Rosana Pacella, Hannah J Thomas, James G Scott, Qinglu Cheng and David Brain declare that they have no conflicts of interest.

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The data used for the study are provided as Online Supplementary Material. More detailed data will be provided upon request.

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The developed model is available as Fig. 1.

Authors’ contributions

Conception and design of work: AJ, RP, DB. Data collection: AJ, DC, DB. Data analyses and interpretation: AJ, DB, NG, QC, RP. Drafting the article: AJ, DB. Critical revision of the article: AJ, DC, NG, RP, HT, JS, QC, DB. Final approval for publication: AJ, DC, NG, RP, HT, JS, QC, DB.

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Jadambaa, A., Graves, N., Cross, D. et al. Economic Evaluation of an Intervention Designed to Reduce Bullying in Australian Schools. Appl Health Econ Health Policy 20, 79–89 (2022).

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