Boyer Nicole R S, Boyd Kathleen A, Turner-Halliday Fiona, Watson Nicholas, Minnis Helen
Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Mental Health & Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK.
BMC Psychiatry. 2014 Dec 10;14:346. doi: 10.1186/s12888-014-0346-0.
Children with maltreatment associated psychiatric problems are at increased risk of developing behavioural or mental health disorders. Dyadic Developmental Psychotherapy (DDP) was proposed as treatment for children with maltreatment histories in the USA, however, being new to the UK little is known of its effectiveness or cost-effectiveness. As part of an exploratory study, this paper explores the feasibility of undertaking economic analysis of DDP in the UK.
Feasibility for economic analysis was determined by ensuring such analysis could meet key criteria for economic evaluation. Phone interviews were conducted with professionals (therapists trained and accredited or in the process of becoming accredited DDP practitioners). Three models were developed to represent alternative methods of DDP service delivery. Once appropriate comparators were determined, economic scenarios were constructed. Cost analyses were undertaken from a societal perspective. Finally, appropriate outcome measurement was explored through clinical opinion, literature and further discussions with clinical experts.
Three DDP models were constructed: DDP Full-Basic, DDP Home-Based and DDP Long-Term. Two potential comparator interventions were identified and defined as Consultation with Carers and Individual Psychotherapy. Costs of intervention completion per case were estimated to be: £6,700 (DDP Full-Basic), £7,100 (Consultations with Carers), £7,200 (DDP Home-Based), £11,400 (Individual Psychotherapy) and £14,500 (DDP Long-Term). None of the models of service delivery were found to currently measure effectiveness consistently. The Strengths and Difficulties Questionnaire (SDQ) was deemed an appropriate primary outcome measure, however, it does not cover all disorders DDP intends to treat and the SDQ is not a direct measure of health gain. Inclusion of quality of life measurement is required for comprehensive economic analysis.
Economic analysis of DDP in the UK is feasible if vital next steps are taken to measure intervention outcomes consistently, ideally with a quality of life measurement. An economic analysis using the models constructed could determine the potential cost-effectiveness of DDP in the UK and identify the most efficient mode of service delivery.
患有与虐待相关精神问题的儿童出现行为或心理健康障碍的风险增加。在美国，二元发展心理治疗（DDP）被提议用于治疗有虐待史的儿童，然而，在英国它尚属新生事物，人们对其有效性或成本效益知之甚少。作为一项探索性研究的一部分，本文探讨了在英国对DDP进行经济分析的可行性。
通过确保此类分析能够满足经济评估的关键标准来确定经济分析的可行性。对专业人员（接受过培训并获得认证或正在成为获得认证的DDP从业者的治疗师）进行了电话访谈。开发了三种模型来代表DDP服务提供的替代方法。一旦确定了合适的对照干预措施，就构建了经济情景。从社会角度进行了成本分析。最后，通过临床意见、文献以及与临床专家的进一步讨论来探索合适的结果测量方法。
构建了三种DDP模型：DDP全基础型、DDP居家型和DDP长期型。确定了两种潜在的对照干预措施，并将其定义为照顾者咨询和个体心理治疗。估计每个案例完成干预的成本为：6700英镑（DDP全基础型）、7100英镑（照顾者咨询）、7200英镑（DDP居家型）、11400英镑（个体心理治疗）和14500英镑（DDP长期型）。目前发现没有一种服务提供模式能够始终如一地衡量有效性。优势与困难问卷（SDQ）被认为是一种合适的主要结果测量方法，然而，它并未涵盖DDP打算治疗的所有障碍，并且SDQ不是健康收益的直接衡量指标。全面的经济分析需要纳入生活质量测量。
如果采取关键的后续步骤来始终如一地测量干预结果，理想情况下采用生活质量测量，那么在英国对DDP进行经济分析是可行的。使用构建的模型进行经济分析可以确定DDP在英国的潜在成本效益，并确定最有效的服务提供模式。
