Long-term cost-utility analysis of family therapy vs. treatment as usual for young people seen after self-harm.
Adolescents
Cost-effectiveness
Hospitalisation
NHS digital
QALY
Self-harm
Journal
Cost effectiveness and resource allocation : C/E
ISSN: 1478-7547
Titre abrégé: Cost Eff Resour Alloc
Pays: England
ID NLM: 101170476
Informations de publication
Date de publication:
29 May 2024
29 May 2024
Historique:
received:
23
05
2023
accepted:
16
04
2024
medline:
30
5
2024
pubmed:
30
5
2024
entrez:
29
5
2024
Statut:
epublish
Résumé
The joint evidence of the cost and the effectiveness of family-based therapies is modest. 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. 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. 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. 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.
Sections du résumé
BACKGROUND
BACKGROUND
The joint evidence of the cost and the effectiveness of family-based therapies is modest.
OBJECTIVE
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 38811931
doi: 10.1186/s12962-024-00546-z
pii: 10.1186/s12962-024-00546-z
doi:
Types de publication
Journal Article
Langues
eng
Pagination
49Subventions
Organisme : Health Technology Assessment Programme
ID : 07/33/01
Organisme : Health Technology Assessment Programme
ID : 07/33/01
Organisme : Health Technology Assessment Programme
ID : 07/33/01
Organisme : Health Technology Assessment Programme
ID : 07/33/01
Informations de copyright
© 2024. The Author(s).
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