Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK.
Mental Health and Wellbeing, University of Glasgow, Glasgow, UK.
BMJ Open. 2018 Mar 14;8(3):e020066. doi: 10.1136/bmjopen-2017-020066.
Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK.
An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)-Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost-utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective).
Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme).
NCT02653716; Pre-results.
经历过虐待和忽视的儿童在一生中面临更高的心理健康和身体健康问题的风险。这给个人、家庭和社会带来了巨大的负担，涉及卫生服务、教育、社会关怀和司法部门。有证据表明，早期干预可以减轻儿童虐待的负面影响，对进入寄养的受虐待儿童的健康产生长期的积极影响。然而，关于这种复杂干预措施的成本效益的证据是有限的。本方案描述了英国首例此类经济评估。
一项经济评估与最佳服务试验（BeST？）一起进行，旨在确定、衡量和评估与新奥尔良干预模式（NIM）（婴儿心理健康服务）相比，常规管理（CM）（增强的社会工作服务）对关键资源和结果的影响。一项基于试验的经济评估和长期模型将从国民保健服务/个人社会服务和更广泛的社会角度进行，同时进行国家健康研究所（NIHR）-公共卫生研究单位（PHRU）资助的随机多中心 BeST？。BeST？旨在评估 NIM 与 CM 对进入英国寄养的受虐待儿童的影响。收集儿科生活质量问卷（PedsQL）并将其最近映射到 EuroQol-5-Dimensions（EQ-5D），将有助于为婴幼儿人群进行成本效用分析估计质量调整生命年。其他有效性结果将纳入成本效益分析（CEA）和成本后果分析（CCA）。长期经济模型和多种经济评估框架将为决策者提供有关 NIM 成本效益的全面、多视角的指南。长期人群健康经济模型将通过试验数据与常规链接数据以及文献中提供的关键政府部门参数进行综合开发。将采用人群健康经济评估方法指南（终生时间范围、成本和效益 1.5%贴现率、CCA 框架、多部门视角）。
西苏格兰伦理委员会已批准该研究。主要试验和经济评估的结果将提交给同行评议期刊发表，并在同行评议的 NIHR 期刊库（公共卫生研究计划）发表。
NCT02653716；预结果。
