Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Tubeuf, Sandy; Guthmuller, Sophie

doi:10.5301/grhta.5000272

Cited by 4 publications

(7 citation statements)

References 45 publications

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“…Notably, the probability of the CCBT+MCI arm being cost-effective lessened when a more restricted NHS perspective was adopted and the gains from reduced school absenteeism and mothers' productivity/employment excluded. This indicates that costs associated with childhood anxiety disorders are likely to be underestimated if a purely healthcare provider perspective is adopted, and it affirms the importance of including wider family/ society born costs and outcomes in mental health economic evaluations (Creswell et al, 2017;Tilford et al, 2015;Tubeuf & Guthmuller, 2017). Despite these potential broader economic benefits, it is important to consider the lack of significant clinical effects of the two active adjunct interventions (MCI/MCBT).…”

Section: Discussionmentioning

confidence: 93%

“…Aggregating direct and spillover effects may alter cost‐effectiveness profiles, a particularly appropriate strategy when the economic evaluation adopts a societal perspective. Indeed, recommendations from a recent review of family‐based therapies suggest that future research in this field should include such spillover effects to the rest of the family as well as consider cost and effectiveness over a longer time horizon (Tubeuf & Guthmuller, ). Further, few evaluations to date have formally aggregated QALYs as a means of capturing spillover effects.…”

Section: Introductionmentioning

confidence: 99%

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A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

Creswell

Violato

Cruddace

et al. 2019

Child Psychology Psychiatry

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BackgroundThis study evaluated whether clinical and economic outcomes from CBT for child anxiety disorders in the context of maternal anxiety disorders are improved by adding treatment focused on (a) maternal anxiety disorders or (b) mother–child interactions.MethodsTwo hundred and eleven children (7–12 years, 85% White British, 52% female) with a primary anxiety disorder, whose mothers also had a current anxiety disorder, were randomised to receive (a) child‐focused CBT with nonspecific control interventions (CCBT+Con), (b) CCBT with CBT for the maternal anxiety disorder (CCBT+MCBT), or (c) CCBT with an intervention targeting the mother–child interaction (CCBT+MCI). A cost‐utility analysis from a societal perspective was conducted using mother/child combined quality‐adjusted life years (QALYs). [Trial registration: https://doi.org/10.1186/isrctn19762288].Results MCBT was associated with immediate reductions in maternal anxiety compared to the nonspecific control; however, after children had also received CCBT, maternal outcomes in the CCBT+MCI and CCBT+Con arms improved and CCBT+MCBT was no longer superior. Neither CCBT+MCBT nor CCBT+MCI conferred a benefit over CCBT+Con in terms of child anxiety disorder diagnoses post‐treatment [primary outcome] (adj RR: 1.22 (95% CI: 0.88, 1.67), p = .23; adj RR: 1.21 (95% CI: 0.88, 1.65), p = .24, respectively) or global improvement ratings (adj RR: 1.25 (95% CI: 0.99, 1.57), p = .06; adj RR: 1.18 (95% CI: 0.93, 1.50), p = .17) or six and 12 months later. No significant differences between the groups were found on the main economic outcome measures (child/mother combined QALY mean difference: CCBT+MCBT vs. CCBT+Con: −0.04 (95% CI: −0.12, 0.04), p = .29; CCBT+MCI vs. CCBT+Con: 0.02 (95% CI: −0.05, −0.09), p = .54). CCBT+MCI was associated with nonsignificantly higher costs than CCBT (mean difference: £154 (95% CI: −£1,239, £1,547), p = .83) but, when taking into account sampling uncertainty, it may be cost‐effective compared with CCBT alone.ConclusionsGood outcomes were achieved for children and their mothers across treatment arms. There was no evidence of significant clinical benefit from supplementing CCBT with either CBT for the maternal anxiety disorder or treatment focussed on mother–child interactions, but the addition of MCI (and not MCBT) may be cost‐effective.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

Creswell

Violato

Cruddace

et al. 2019

Child Psychology Psychiatry

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“…lost productivity). The importance of documenting child mental health ‘spillover effects’ on the family and wider society, in terms of both health outcomes and costs, has been much emphasised, especially in the economic literature (Al‐Janabi et al., 2016 ; Knapp & Wong, 2020 ; Tubeuf & Guthmuller, 2017 ), yet evidence on these aspects is still scarce. Future research should therefore address these important gaps in knowledge both in economic studies as well as more general longitudinal studies, as previously emphasised.…”

Section: Discussionmentioning

confidence: 99%

“…Our review also highlighted the short time horizons of all the economic studies considered, with the longest follow up period being 2 years. As demonstrated, childhood anxiety problems have pervasive and long‐lasting clinical and economic impacts, so another important direction for future research is to investigate the long‐term economic consequences of these debilitating illnesses (Knapp & Wong, 2020 ; Tubeuf & Guthmuller, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta‐analysis

et al. 2023

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BackgroundOver a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs.MethodsA systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual‐, family‐ or societal‐level outcome or cost. All studies were synthesised narratively. For longitudinal studies, ‘effect direction’ was used as a common metric, with random effects meta‐analysis undertaken where possible.ResultsEighty‐three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta‐analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self‐harm, eating, relationship, educational, health care, employment, and financial outcomes. ‘Effect direction’ was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow‐up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP).ConclusionsChildhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost‐effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long‐term, economic‐related, consequences of childhood anxiety problems.

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“…However, the joint evidence of the cost and the effectiveness of family-based therapies is limited. A review of the evidence regarding economic studies based on 16 studies concluded that family-based interventions focusing on children and adolescents’ health disorders were cost-effective in only two third of the studies [ 17 ]. This review also showed that the quality of the economic evaluations of family-based intervention for young people and children was limited.…”

Section: Introductionmentioning

confidence: 99%

Long-term cost-utility analysis of family therapy vs. treatment as usual for young people seen after self-harm

Bojke,

Cottrell,

Wright-Hughes

et al. 2024

Cost Eff Resour Alloc

Self Cite

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Background The joint evidence of the cost and the effectiveness of family-based therapies is modest. Objective To study the cost-effectiveness of family therapy (FT) versus treatment-as-usual (TAU) for young people seen after self-harm combining data from an 18-month trial and hospital records up to 60-month from randomisation. Methods We estimate the cost-effectiveness of FT compared to TAU over 5 years using a quasi-Markov state model based on self-harm hospitalisations where probabilities of belonging in a state are directly estimated from hospital data. The primary outcome is quality-adjusted life years (QALY). Cost perspective is NHS and PSS and includes treatment costs, health care use, and hospital attendances whether it is for self-harm or not. Incremental cost-effectiveness ratios are calculated and deterministic and probabilistic sensitivity analyses are conducted. Results Both trial arms show a significant decrease in hospitalisations over the 60-month follow-up. In the base case scenario, FT participants incur higher costs (mean +£1,693) and negative incremental QALYs (-0.01) than TAU patients. The associated ICER at 5 years is dominated and the incremental health benefit at the £30,000 per QALY threshold is -0.067. Probabilistic Sensitivity Analysis finds the probability that FT is cost-effective is around 3 − 2% up to a maximum willingness to pay of £50,000 per QALY. This suggest that the extension of the data to 60 months show no difference in effectiveness between treatments. Conclusion Whilst extended trial follow-up from routinely collected statistics is useful to improve the modelling of longer-term cost-effectiveness, FT is not cost-effective relative to TAU and dominated in a cost-utility analysis.

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Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Cited by 4 publications

References 45 publications

A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta‐analysis

Long-term cost-utility analysis of family therapy vs. treatment as usual for young people seen after self-harm

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