@article {4776, title = {Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial}, journal = {Health Policy Plan}, volume = {31}, number = {4}, year = {2016}, note = {McBain, Ryan K
Salhi, Carmel
Hann, Katrina
Salomon, Joshua A
Kim, Jane J
Betancourt, Theresa S
eng
P30 AG024409/AG/NIA NIH HHS/
1F31MH097333-01A1/MH/NIMH NIH HHS/
5K01MH077246-05/MH/NIMH NIH HHS/
5P30AG024409-08/AG/NIA NIH HHS/
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
England
2015/09/09 06:00
Health Policy Plan. 2016 May;31(4):415-24. doi: 10.1093/heapol/czv078. Epub 2015 Sep 7.}, month = {May}, pages = {415-24}, abstract = {BACKGROUND: One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. METHODS: The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An {\textquoteright}ingredients approach{\textquoteright} estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. RESULTS: Retention at 6-month follow-up was 85\% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers{\textquoteright} interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. CONCLUSIONS: The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials. TRIAL REGISTRATION: clinicaltrials.gov Identifier: RPCGA-YRI-21003.}, keywords = {*Cost-effectiveness analysis, *disability, *Health Care Costs, *Mental Health, *school, *sub-Saharan Africa, *war, *Warfare, Adolescent, Cost-Benefit Analysis, Female, Humans, Male, Mental Health Services/economics, Psychotherapy, Group/*economics/methods, Sierra Leone, Stress, Psychological/*etiology/therapy, Treatment Outcome, Young Adult}, isbn = {1460-2237 (Electronic)
0268-1080 (Linking)}, author = {McBain, R. K. and Salhi, C. and Hann, K. and Salomon, J. A. and Kim, J. J. and Betancourt, T. S.} }