The search for relevant outcome measures for cost-utility analysis of systemic family interventions in adolescents with substance use disorder and delinquent behavior: a systematic literature review

Abstract

PurposeSystemic family interventions have shown to be effective in adolescents with substance use disorder and delinquent behavior. The interventions target interactions between the adolescent and involved systems (i.e. youth, family, peers, neighbors, school, work, and society). Next to effectiveness considerations, economic aspects have gained attention. However, conventional generic quality of life measures used in health economic evaluations may not be able to capture the broad effects of systemic interventions. This study aims to identify existing outcome measures, which capture the broad effects of systemic family interventions, and allow use in a health economic framework.MethodsWe based our systematic review on clinical studies in the field. Our goal was to identify effectiveness studies of psychosocial interventions for adolescents with substance use disorder and delinquent behavior and to distill the instruments used in these studies to measure effects. Searched databases were PubMed, Education Resource Information Center (ERIC), Cochrane and Psychnet (PsycBOOKSc, PsycCRITIQUES, print). Identified instruments were ranked according to the number of systems covered (comprehensiveness). In addition, their use for health economic analyses was evaluated according to suitability characteristics such as brevity, accessibility, psychometric properties, etc.ResultsOne thousand three hundred seventy-eight articles were found and screened for eligibility. Eighty articles were selected, 8 instruments were identified covering 5 or more systems.ConclusionsThe systematic review identified instruments from the clinical field suitable to evaluate systemic family interventions in a health economic framework. None of them had preference-weights available. Hence, a next step could be to attach preference-weights to one of the identified instruments to allow health economic evaluations of systemic family interventions.

Presentation and validation of the Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI): A preference-based measure for use in health-economic evaluations

“…The ASC T-ASI was developed and validated in three consecutive steps. First, the T-ASI was identified as a suitable measure for capturing the broad benefits of youth mental health interventions [ 14 ]. The self reported items were selected from the domains of the T-ASI to generate the ASC T-ASI descriptive system.…”

“…Schawo et al [ 14 ] conducted a systematic literature review and selected the (non-preference based) Teen-Addiction Severity Index (T-ASI) [ 26 ] as a comprehensive measure for capturing the broad benefits of youth mental health interventions. The T-ASI covers the domains substance use, school, work, family, social relationships, justice, and mental health.…”

“…Although these generic measures can be used to estimate QALY gains and facilitate the allocation of scarce healthcare resources across patient populations and competing health interventions [5], there is growing recognition of the relevance of treatment-related benefits beyond health and HRQOL as captured by common QALY measures. In the treatment of adolescents with mental health problems, including those with problems associated with substance use and delinquency, concerns have been raised regarding the sensitivity and comprehensiveness of generic preference-based measures, such as the EQ-5D, in capturing all relevant treatment benefits [7,[13][14][15][16]. For example, the EQ-5D has been found to be unresponsive to health changes in some populations with more complex mental health problems [17,18].…”

Broadening the application of health technology assessment in the Netherlands: a worthwhile destination but not an easy ride?

“…Intended outcomes of such interventions may include well-being, autonomy, reduced criminality or drug abuse, and social participation (e.g. Schawo et al ., 2017 ). Such goals stress the need for adequate outcome measures, which may not be readily available.…”

Obtaining preference scores for an abbreviated self-completion version of the Teen-Addiction Severity Index (ASC T-ASI) to value therapy outcomes of systemic family interventions: a discrete choice experiment

“…These measures capture broader life domains than health and are suitable for use in economic evaluations. In other areas, including mental health care and addiction-related treatments, broader preference-based outcome measures are also required but largely lacking [ 9 – 14 ]. The issue of appropriate and comprehensive outcome measures, preference-based, and suitable for use in economic evaluations, is highly relevant in the context of mental health interventions, and particularly for systemic family interventions.…”