A guide to cost-effectiveness acceptability curves

Use of cost-effectiveness acceptability curves, as a method for summarising information on uncertainty in cost-effectiveness, has become widespread within applied studies. This includes several studies in the mental health field. This editorial uses examples from recent papers to illustrate how cost-effectiveness acceptability curves are constructed, what they represent and how they should be interpreted

Economic evaluations of child and adolescent mental health interventions : a systematic review.

BACKGROUND : The need has grown over recent years for economic information on the impacts of child and adolescent mental helath problems and the cost-effectiveness of interventions. METHODS : A range of electronic databases were searched using a predefined search strategy. To identify economic studies which focused on services, pharmacological interventions and other treatments for children and adolescents with a diagnosed mental health problem or identified as at risk of mental illness. Published studies were included in the review if they assessed both costs and outcomes, with cost-effectiveness being the primary interest. Articles meeting the criteria for inclusion were assessed for quality. RESULTS : Behavioural disorders have been given relatively large attention in economic evaluations of child and adolescent mental health. These studies tentatively suggest child behavioural gains and parent satisfaction from parent and child training programmes, however the cost effectiveness of the location of delivery for behvaioural therapies is less clear. In general the quality of economic evaluations was limited by small sample sizes, a narrow conceptualisation of costs, narrow perspectives and limited statistical and econometric methods. CONCLUSIONS : Economic evaluations in the field of child and adolescent mental health services are few in number and generally poor in quality, although the number of studies being undertaken is now rising relatively quickly.

Economic Evaluation of Multisystemic Therapy for Young People at Risk for Continuing Criminal Activity in the UK

Abstract Objective: To evaluate whether multisystemic therapy (MST) is more cost-effective than statutory interventions that are currently available for young offenders in England. Method: A cost-offset evaluation of MST based on data from a randomised controlled trial conducted in North London, England, comparing MST with usual services provided by two youth offending teams (YOT). Service costs were compared to cost savings in terms of rates of criminal re-offending. Results: 108 adolescents, aged 11–17 years, were randomly allocated to MST+YOT (n = 56) or YOT alone (n = 52). Reductions in offending were evident in both groups, but were higher in the MST+YOT group. At 18-month follow-up, the MST+YOT group cost less in terms of criminal activity (£9,425 versus £11,715, p = 0.456). The MST+YOT group were significantly cheaper in terms of YOT services than the YOT group (£3,402 versus £4,619, p = 0.006), but more expensive including the cost of MST, although not significantly so (£5,687 versus £4,619, p = 0.195). The net benefit per young person for the 18-month follow-up was estimated to be £1,222 (95% CI 2£5,838 to £8,283). Conclusions: The results reported in this study support the finding that MST+YOT has scope for cost-savings when compared to YOT alone. However, the limitations of the study in terms of method of economic evaluation, outcome measures used and data quality support the need for further research

Clinical Pathway for Comorbid ED and ASC

This is the peer reviewed version of the following article: Tchanturia, K., Dandil, Y., Li, Z., Smith, K., Leslie, M., & Byford, S. (2020). A Novel Approach for Autism Spectrum Condition patients with Eating Disorders: Analysis of Treatment Cost-savings. European Eating Disorders Review, 29(3), 514-518, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1002/erv.2760. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Objective: In the current economic context, it is critical to ensure that eating disorder (ED) treatments are both effective and cost-effective. We describe the impact of a novel clinical pathway developed to better meet the needs of autistic patients with EDs on the length and cost of hospital admissions. Method: The pathway was based on the Institute for Healthcare’s Model of Improvement methodology, using an iterative Plan, Do, Study, Act format to introduce change and to co-produce the work with people with lived experience and with healthcare professionals. We explored the change in length and cost of admissions before and after the pathway was introduced. Results: Preliminary results suggest that the treatment innovations associated with this pathway have led to reduced lengths of admission for patients with the comorbidity, which were not seen for patients without the comorbidity. Estimated cost-savings were approximately £22,837 per patient and approximately £275,000 per year for the service as a whole. Conclusion: Going forward, our aim is to continue to evaluate the effectiveness and cost-effectiveness of investment in the pathway to determine whether the pathway improves the quality of care for patients with a comorbid ED and autism and is good value for money

Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT): evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK

Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT) has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities, although the evidence regarding the safety, efficacy and cost effectiveness of this treatment approach remains equivocal. Recent British clinical guidance indicates that IOT should be a second-line treatment for those patients in high-quality oral methadone treatment who continue to regularly inject heroin, and that treatment be initiated in newly-developed supervised injecting clinics. The Randomised Injectable Opioid Treatment Trial (RIOTT) is a multisite, prospective open-label randomised controlled trial (RCT) examining the role of treatment with injected opioids (methadone and heroin) for the management of heroin dependence in patients not responding to conventional substitution treatment. Specifically, the study examines whether efforts should be made to optimise methadone treatment for such patients (e.g. regular attendance, supervised dosing, high oral doses, access to psychosocial services), or whether such patients should be treated with injected methadone or heroin. Eligible patients (in oral substitution treatment and injecting illicit heroin on a regular basis) are randomised to one of three conditions: (1) optimized oral methadone treatment (Control group); (2) injected methadone treatment; or (3) injected heroin treatment (with access to oral methadone doses). Subjects are followed up for 6-months, with between-group comparisons on an intention-to-treat basis across a range of outcome measures. The primary outcome is the proportion of patients who discontinue regular illicit heroin use (operationalised as providing >50% urine drug screens negative for markers of illicit heroin in months 4 to 6). Secondary outcomes include measures of other drug use, injecting practices, health and psychosocial functioning, criminal activity, patient satisfaction and incremental cost effectiveness. The study aims to recruit 150 subjects, with 50 patients per group, and is to be conducted in supervised injecting clinics across England

Stroke rehabilitation: a cost-effectiveness analysis of a placement scheme

The Leeds Stroke Rehabilitation Placement Scheme (SRPS) provides short-term intensive support for vulnerable stroke patients on discharge from hospital. A previous study at one year post stroke established the benefits of this community support, demonstrating that patients involved in the scheme were more likely to maintain their three-month post stroke functional ability than patients discharged directly at home, as is conventional. Given the scarcity of resources, however, it is important to demonstrate not only the effectiveness of an intervention but also the cost-effectiveness, in order to ensure that resources are allocated efficiently. The aim of this study was to combine the previously reported effectiveness data with newly gathered cost information, to carry out a cost-effectiveness analysis of the SRPS. The results show that the SRPS attained a unit increase in functional ability, as given by the Barthel Activities of Daily Living Index, at lower cost (£586.85) than the alternative of discharging patients directly home (£5859.48). Although methodological problems and limitations in the data allow only tentative conclusions to be made, the study does highlight the practical problems encountered in the field of cost-effectiveness analysis and makes a number of recommendations to guide future evaluations of stroke rehabilitation services.stroke rehabilitation, activities of daily living

Assessing the validity of the ICECAP-A capability measure for adults with depression

BACKGROUND: Effectiveness and cost-effectiveness are increasingly important considerations in determining which mental health services are funded. Questions have been raised concerning the validity of generic health status instruments used in economic evaluation for assessing mental health problems such as depression; measuring capability wellbeing offers a possible alternative. The aim of this study is to assess the validity of the ICECAP-A capability instrument for individuals with depression. METHODS: Hypotheses were developed using concept mapping. Validity tests and multivariable regression analysis were applied to data from a cross-sectional dataset to assess the performance of ICECAP-A in individuals who reported having a primary condition of depression. The ICECAP-A was collected alongside instruments used to measure: 1. depression using the depression scale of the Depression, Anxiety and Stress Scale (DASS-D of DASS-21); 2. mental health using the Kessler Psychological Distress Scale (K10); 3. generic health status using a common measure collected for use in economic evaluations, the five level version of EQ-5D (EQ-5D-5L). RESULTS: Hypothesised associations between the ICECAP-A (items and index scores) and depression constructs were fully supported in statistical tests. In the multivariable analysis, instruments designed specifically to measure depression and mental health explained a greater proportion of the variation in ICECAP-A than the EQ-5D-5L. CONCLUSION: The ICECAP-A instrument appears to be suitable for assessing outcome in adults with depression for resource allocation purposes. Further research is required on its responsiveness and use in economic evaluation. Using a capability perspective when assessing cost-effectiveness could potentially re-orientate resource provision across physical and mental health care services. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-017-1211-8) contains supplementary material, which is available to authorized users