Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 15, Issue 4, 2012. Pages: 187-196
Published Online: 1 December 2012

Framework for Modelling the Cost-effectiveness of Systemic Interventions Aimed to Reduce Youth Delinquency

Saskia J Schawo,¹* Hester van Eeren,² Djíra I Soeteman,³ Marie-Christine van der Veldt,⁴ Marc J Noom,⁵ Werner Brouwer,⁶ Jan JV Busschbach,⁷ Leona Hakkaart⁸

¹MSc, Institute of Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
²MSc, Institute of Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, Viersprong Institute for Studies on Personality Disorders (VISPD) and Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
³PhD, Center for Health Decision Science, Harvard School of Public Health, U.S.
⁴MSc, PI Research, The Netherlands
⁵PhD, Department of Clinical Psychology, University of Amsterdam, and Viersprong Institute for Studies on Personality Disorders (VISPD), The Netherlands
⁶Professor, Institute of Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
⁷Professor, Viersprong Institute for Studies on Personality Disorders (VISPD) and Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
⁸Associate Professor, Institute of Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, The Netherlands

* Correspondence to: Saskia J Schawo, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Room J5-059, P.O.Box 1738, 3000 DR Rotterdam, The Netherlands.
Tel.: +31-10-408 2581
Fax: +31-10-408 9094
E-mail: schawo@bmg.eur.nl

Sources of Funding: All authors declare to have no conflict of interests. The study was conducted with a grant from ZonMw, The Hague.

Abstract

Systemic interventions for delinquent youth compete with medical treatments for health care budgets. However, as a challenge to the health economist, the interventions not necessarily primarily aim to improve health. We investigated whether cost-effectiveness methods common in medical interventions are feasible for evaluations regarding youth delinquency. A probabilistic Markov model was constructed. For illustrative purposes, Functional Family Therapy was compared to Treatment as Usual. “Criminal activity free years” were introduced as primary outcome measure. The probabilistic model and outcome measure proved feasible. Common cost-effectiveness methodology could be applied to systemic interventions for delinquent youth. The model provides a framework to assess cost-effectiveness of systemic interventions considering parameter uncertainty and long-term effectiveness. However, as model parameters were retrieved from literature model results are illustrative. Future research may focus on testing the model with extensive empirical data, extending model states, improving the outcome measure and finding appropriate values for that outcome.

Background: Many interventions initiated within and financed from the health care sector are not necessarily primarily aimed at improving health. This poses important questions regarding the operationalisation of economic evaluations in such contexts.

Aims of the Study: We investigated whether assessing cost-effectiveness using state-of-the-art methods commonly applied in health care evaluations is feasible and meaningful when evaluating interventions aimed at reducing youth delinquency.

Methods: A probabilistic Markov model was constructed to create a framework for the assessment of the cost-effectiveness of systemic interventions in delinquent youth. For illustrative purposes, Functional Family Therapy (FFT), a systemic intervention aimed at improving family functioning and, primarily, reducing delinquent activity in youths, was compared to Treatment as Usual (TAU). ``Criminal activity free years'' (CAFYs) were introduced as central outcome measure. Criminal activity may e.g. be based on police contacts or committed crimes. In absence of extensive data and for illustrative purposes the current study based criminal activity on available literature on recidivism. Furthermore, a literature search was performed to deduce the model's structure and parameters.

Results: Common cost-effectiveness methodology could be applied to interventions for youth delinquency. Model characteristics and parameters were derived from literature and ongoing trial data. The model resulted in an estimate of incremental costs/CAFY and included long-term effects. Illustrative model results point towards dominance of FFT compared to TAU.

Discussion: Using a probabilistic model and the CAFY outcome measure to assess cost-effectiveness of systemic interventions aimed to reduce delinquency is feasible. However, the model structure is limited to three states and the CAFY measure was defined rather crude. Moreover, as the model parameters are retrieved from literature the model results are illustrative in the absence of empirical data.

Implications for Health Care Provision and Use : The current model provides a framework to assess the cost-effectiveness of systemic interventions, while taking into account parameter uncertainty and long-term effectiveness.

Implications for Health Policies: The framework of the model could be used to assess the cost-effectiveness of systemic interventions alongside (clinical) trial data. Consequently, it is suitable to inform reimbursement decisions, since the value for money of systemic interventions can be demonstrated using a decision analytic model.

Implications for Further Research: Future research could be focussed on testing the current model based on extensive empirical data, improving the outcome measure and finding appropriate values for that outcome.

Received 14 December 2011; accepted 25 October 2012