Economic evaluation of a complex intervention to improve the mental health of maltreated children in foster care (BeST? Services trial).

Manuela Deidda, Helen Minnis, Karen Crawford, Robin Young, Gary Kainth, Julia Donaldson, Matt Forde, Alex McConnachie, Christopher Gillberg, Marion Henderson, Philip Wilson, Kathleen A Boyd, Emma McIntosh
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Abstract

Background: Children in foster care who have experienced abuse and neglect are at risk of poor long-term health and societal outcomes. Evidence on the costs, benefits and cost-effectiveness of early interventions aimed at improving the mental health of abused and neglected children is limited.

Methods: This study reports the within-trial economic evaluation alongside BEST?, a randomized controlled trial comparing the New Orleans Intervention Model (NIM) with services as usual (SAU), targeting children aged 0-60 months entering UK foster care.In line with guidance for conducting economic evaluations of complex and social care interventions, a cost-utility analysis (CUA) estimated incremental cost of NIM per quality-adjusted life year (QALY); a cost-effectiveness analysis estimated incremental cost per unit improvement in child mental health; and a cost-consequence analysis combined costs with broad-ranging outcomes.

Results: NIM is significantly more costly than SAU (NIM: £10 002; SAU: £4336), with wide cost variations according to context. There are no significant differences between NIM and SAU in QALYs or child mental health.

Conclusions: Within the current UK care systems, NIM is not a cost-effective alternative to SAU. However, these results need to be interpreted with caution and within the prevailing service provision context.

改善寄养中受虐待儿童心理健康的综合干预的经济评价(BeST?服务审判)。
背景:经历过虐待和忽视的寄养儿童面临长期健康和社会后果不佳的风险。关于旨在改善受虐待和被忽视儿童心理健康的早期干预措施的成本、收益和成本效益的证据有限。方法:本研究报告试验内经济评价与BEST?是一项比较新奥尔良干预模式(NIM)和常规服务(SAU)的随机对照试验,目标是进入英国寄养的0-60个月的儿童。根据对复杂和社会护理干预措施进行经济评估的指导,成本效用分析(CUA)估计了每个质量调整生命年(QALY)的NIM增量成本;成本效益分析估计了儿童心理健康每单位改善的增量成本;成本-后果分析将成本与广泛的结果结合起来。结果:NIM的成本明显高于SAU (NIM:£10 002;SAU: 4336英镑),根据上下文有很大的成本变化。NIM和SAU在QALYs和儿童心理健康方面没有显著差异。结论:在目前的英国护理系统中,NIM不是SAU的一种具有成本效益的替代方案。然而,这些结果需要在当前的服务提供上下文中谨慎解释。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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