Intervening in youth problem behavior in Sweden: a pragmatic cost analysis of MST from a randomized trial with conduct disordered youth

Abstract

Olsson TM. Intervening in youth problem behavior in Sweden: a pragmatic cost analysis of MST from a randomized trial with conduct disordered youth Int J Soc Welfare 2010: 19: 194–205 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. Within the context of a randomized trial, this study assessed the costs of treating conduct disorder with multisystemic therapy (MST) or treatment as usual (TAU) for 156 youth in Sweden. From the perspective of the municipal Social Welfare Administration, all intervention costs were collected for the 6‐month period starting at randomization. MST was found to cost, on average, US$8,847 per youth. A course of intervention including MST was found to cost significantly more (US$5,038 per youth) than TAU. Although MST was found to reduce the use of and costs associated with non‐placement interventions, MST was not found to reduce the use of or costs associated with placement interventions. This is contrary to findings reported from studies undertaken in the USA. Intent‐to‐treat (ITT) and treatment‐of‐treated (TOT) analyses are presented.

Comparing top-down and bottom-up costing approaches for economic evaluation within social welfare

“…As such, it is a source which is unable to capture cost variation between patients. In addition, the average unit cost for the interventions provided is characterized by high variation [25]. Even so, this study found that both the top-down and bottom-up approaches were reliable, indicating that for purposes of economic evaluation both approaches may be useful when difference in cost is of concern as opposed to absolute cost.…”

“…When a unit cost could not be estimated through one of the aforementioned methods, a unit cost was estimated by taking the average of the available unit costs as calculated by one of the aforementioned methods (n = 151). The average was calculated by intervention type [24,25] and (calendar) year. For example, the average unit cost for all counseling services during 2006 or the average unit cost for aggression replacement training (ART) during 2004.…”

Economic Evaluation as a Component of Quality Effectiveness Research: Methodological and Practical Benefits

“…For example, there are several methodological options available for the estimation of unit price (ibid., for empirical example see, Olsson 2010a). An investigator may, through sensitivity analysis, choose to adjust the unit price estimate in order to assess how method or other factors may have impacted the results of the economic evaluation (e.g., Olsson 2009Olsson , 2010b. Similarly, an investigator may choose to incorporate other studies' clinical results or make changes to organizational variables to test how changes in effectiveness or organizational efficiency might impact an intervention's economic result.…”

The Impact of Family Service Involvement on Treatment Completion and General Recidivism Among Male Youthful Sexual Offenders

“…Lastly, services that integrate multiple systems can be costly. Although such services have been supported by evidence (Letourneau et al, 2009), the inclusion of multiple individuals, treatment protocols, and provider training can lead to a greater expense (Harpell & Andrews, 2006;Olsson, 2010), limiting accessibility for many with economic disparities. Despite these and other service challenges, professionals are increasingly valuing systemic and family-oriented models of service delivery.…”