Schawo Saskia J, Brouwer Werner B F, Hakkaart Leona
Institute for Medical Technology Assessment and Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands,
J Ment Health Policy Econ. 2017 Sep 1;20(3):131-136.
Systemic interventions focus on improvements of interactions between clients and their environments, and are increasingly used to treat adolescents with problems of substance use and delinquency. Clients' progress may include broad and non-medical effects. When performing economic evaluations of these interventions, the common outcome of costs per quality adjusted life year (cost/QALY) may not capture all of these effects.
The current study is an explorative study. It aims to investigate which outcomes clinicians consider relevant to the therapeutic success of systemic interventions and whether these, according to them, are sufficiently captured by the EQ-5D instrument.
Semi-structured interviews were performed with seven clinicians at two mental health institutions in the Netherlands. Clinicians were asked to list the most relevant outcomes of systemic interventions. They were asked whether they considered the EQ-5D dimensions to sufficiently capture these outcomes or if they missed aspects or outcome domains.
The clinicians mentioned several broad effects relevant for the evaluation of systemic interventions. These were aspects of family functioning, parental functioning, social competencies, school attendance, etc. They considered several EQ-5D dimensions relevant (i.e. in particular 'usual activities' and 'anxiety/depression'), yet they indicated that the instrument lacked systemic dimensions (i.e. family relations and relations with others) and addiction-related aspects.
The interviewed clinicians considered several dimensions of the EQ-5D useful in evaluating effects of systemic interventions, yet they expressed the need to add additional dimensions particularly relevant to systemic aspects to the instrument when performing economic evaluations of systemic interventions. The explorative analysis was limited by the small number of interviewed clinicians. Furthermore, a relatively high proportion of clinicians were specialized in Multidimensional Family Therapy, a type of systemic intervention particularly used to treat adolescents with substance use disorders and related problems. Hence the importance of addiction-related improvements may have been over-emphasized in this group of respondents.
Practical implications of the current study may be the need for enhancements of the current health economic methodology for evaluating systemic interventions as to capture additional aspects specifically relevant to these interventions. This may lead to different choices in the use of instruments for the evaluation of treatment progress and success in clinical practice.
By improving the health economic toolkit to evaluate systemic interventions one may provide policy recommendations in line with the therapeutic goals of the interventions.
Further research could be directed at investigating the suitability of other available instruments than the EQ-5D for economic evaluations of systemic interventions.
系统性干预聚焦于改善服务对象与其环境之间的互动，并且越来越多地用于治疗有药物使用问题和犯罪行为的青少年。服务对象的进展可能包括广泛的非医学方面的影响。在对这些干预措施进行经济评估时，每质量调整生命年成本（成本/质量调整生命年）这一常见结果可能无法涵盖所有这些影响。
本研究是一项探索性研究。其目的是调查临床医生认为哪些结果与系统性干预的治疗成功相关，以及根据他们的看法，欧洲五维健康量表（EQ - 5D）工具是否能充分涵盖这些结果。
对荷兰两家心理健康机构的七位临床医生进行了半结构化访谈。要求临床医生列出系统性干预最相关的结果。询问他们是否认为EQ - 5D维度能充分涵盖这些结果，或者是否遗漏了某些方面或结果领域。
临床医生提到了几个与评估系统性干预相关的广泛影响。这些包括家庭功能、父母功能、社交能力、上学出勤率等方面。他们认为EQ - 5D的几个维度是相关的（特别是“日常活动”和“焦虑/抑郁”），然而他们指出该工具缺乏系统性维度（即家庭关系和与他人的关系）以及与成瘾相关的方面。
接受访谈的临床医生认为EQ - 5D的几个维度在评估系统性干预的效果方面是有用的，但他们表示在对系统性干预进行经济评估时，需要在该工具中增加与系统性方面特别相关的其他维度。探索性分析受到访谈临床医生数量较少的限制。此外，相对较高比例的临床医生专门从事多维家庭治疗，这是一种特别用于治疗有药物使用障碍及相关问题青少年的系统性干预方法。因此，在这组受访者中，与成瘾相关的改善的重要性可能被过度强调了。
本研究的实际意义可能在于需要改进当前用于评估系统性干预的卫生经济方法，以涵盖与这些干预特别相关的其他方面。这可能会导致在临床实践中用于评估治疗进展和成功的工具使用上产生不同选择。
通过改进用于评估系统性干预的卫生经济工具包，人们可以提供与干预的治疗目标一致的政策建议。
进一步的研究可以针对调查除EQ - 5D之外的其他可用工具对系统性干预经济评估的适用性。
