Vermeulen Karin M, Jansen Daniëlle E M C, Knorth Erik J, Buskens Erik, Reijneveld Sijmen A
Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
Crim Behav Ment Health. 2017 Feb;27(1):89-102. doi: 10.1002/cbm.1988. Epub 2016 Jan 15.
Behavioural problems are common among adolescents. The burden on society in social disturbance, health, failures to contribute and costs has triggered innovative community-based interventions such as multisystemic therapy (MST).
Our aim was to compare the cost-effectiveness of MST and treatment as usual (TAU).
Cost-effectiveness was assessed alongside a randomised clinical trial. One hundred and sixteen adolescents were allocated to MST or TAU. Follow-up lasted six months. Quality of life (EQ-5D) as perceived by the adolescents was the primary outcome. A societal perspective was used for cost assessment.
There was no significant difference between groups in the small improvement experienced in quality of life (EQ-5D average score improvement in both 0.02 points, standard deviation 0.13 MST; 0.23 TAU). Dropout before follow-up was 48% and 69% respectively. Overall costs attributed to these young people were, however, 50% lower in the MST group. The incremental cost-effectiveness ratio (ICER) was 384,633€ (95% CI: -2,001,433 to 2,024,681€), which indicates dominance of MST over TAU.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our study shows that, at worst, MST offers no advantage to young offenders in terms of their experienced quality of life, but 'TAU' included family focused intervention as well as standard supervision. There were some cost advantages for the individual and his/her family in the MST group, but substantial cost benefits for wider society. The case for a large, multi-centre, perhaps international trial is strong as widespread implementation of MST would benefit everyone if these findings are confirmed. Copyright © 2016 John Wiley & Sons, Ltd.
行为问题在青少年中很常见。社会干扰、健康、无法做出贡献以及成本等方面给社会带来的负担引发了基于社区的创新干预措施，如多系统治疗（MST）。
我们的目的是比较MST与常规治疗（TAU）的成本效益。
在一项随机临床试验中评估成本效益。116名青少年被分配接受MST或TAU治疗。随访持续6个月。青少年所感知的生活质量（EQ - 5D）是主要结局。采用社会视角进行成本评估。
两组在生活质量方面的微小改善没有显著差异（EQ - 5D平均得分改善在MST组为0.02分，标准差0.13；TAU组为0.23分）。随访前的脱落率分别为48%和69%。然而，MST组中这些年轻人的总体成本低50%。增量成本效益比（ICER）为384,633欧元（95%可信区间：-2,001,433至2,024,681欧元），这表明MST相对于TAU具有优势。
结论/对实践的启示：我们的研究表明，在最不利的情况下，MST在青少年罪犯所体验的生活质量方面没有优势，但“TAU”包括以家庭为重点的干预以及标准监管。MST组对个人及其家庭有一些成本优势，但对更广泛的社会有显著的成本效益。如果这些发现得到证实，大规模、多中心、甚至国际试验的理由很充分，因为广泛实施MST将使每个人受益。版权所有© 2016约翰威立父子有限公司。
