Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.
Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.
J Dual Diagn. 2021 Oct-Dec;17(4):333-343. doi: 10.1080/15504263.2021.1965409. Epub 2021 Sep 26.
Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyze the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU).
We performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up.
There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [-€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [-0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs.
At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs.
针对双重诊断患者的干预措施的经济评估很少。最近的一项随机对照试验支持 Self-wise, Otherwise, Streetwise（SOS）培训在减少双重诊断患者受害方面的有效性。本研究的目的是分析 SOS 培训作为附加护理的成本效益和成本效用，即作为常规护理（CAU）的附加护理。
我们在 SOS 试验的同时从社会角度进行了经济评估。参与者是从荷兰一家大型城市精神病服务机构的三个地点招募的 250 名双重诊断患者。主要结果是治疗对受害的反应和质量调整生命年（QALYs）。在 14 个月的随访中，同时测量成本和效果。
CAU+SOS 和 CAU 的总费用（平均差异€4859；95%CI[-€4795 至 €14513]）和 QALY 收益（平均差异 0.0012；95%CI[-0.05 至 0.05]）之间没有显著差异。与 CAU 相比，更多的 CAU+SOS 参与者在受害治疗反应上取得了显著效果（68%比 54%；平均差异 0.14；95%CI[0.02 至 0.26]）。成本效益分析表明，与 CAU 相比，CAU+SOS 以更高的成本获得更高的受害治疗反应率的可能性为 83%。成本效用分析表明，在常规意愿支付水平下，SOS 培训与 CAU 相比，对 QALY 可能不具有成本效益。
在社会意愿支付达到 38000 欧元或更高的情况下，与单独的 CAU 相比，将 SOS 培训添加到常规护理中可能更具吸引力，因为成本效益更高。这是一个相当高的意愿支付。然而，提供 SOS 培训的直接成本预计很小。由于随访时间短，以及除监狱费用外，减少警察和司法费用的潜在数据缺失，我们的发现应谨慎解释。
