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Evaluation economique d'un programme simule de psychotherapie breve pour enfants presentant des troubles legers [Economic evaluation of a simulated program of brief psychotherapy for children with mild problems] |
Poinsier B, Laurin A S |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology An early and short-term psychotherapy programme for pre-school children was compared with traditional treatments and care.
Economic study type Cost-effectiveness analysis.
Study population The study population consisted of pre-school children affected by mild behaviour disorders (n=452,795).
Setting The setting was community services (CLSC). The economic study was conducted in Canada.
Dates to which data relate The effectiveness analysis was based on a simulation analysis in which the effectiveness data were derived from a study published in 1991 (see Other Publications of Related Interest). The cost estimates were derived from studies published between 1988 and 1991. All costs were reported in Canadian dollars at 1991 prices.
Source of effectiveness data The effectiveness of the psychotherapeutic programme was gathered from a single study, which reported the effects of brief targeted therapy on children's medical care utilisation. Sources of quality-of-life weights were not reported.
Link between effectiveness and cost data The effectiveness and cost data were applied on the same simulation cohort of children aged between 1 and 5 years old (n=452,795). The two groups of children compared were a "control group" with standard medical care and a "treatment group" with additional psychotherapy examinations. The number of children in each group was not stated.
Modelling A simulation approach was conducted, but the method used was not reported.
Outcomes assessed in the review The outcomes assessed were the prevalence of mild behaviour problems and the effectiveness of psychotherapy treatment. It was unclear whether quality of life adjustments for children affected by mild behaviour disorders were assessed from Finney's study, experts consensus or authors' assumptions.
Study designs and other criteria for inclusion in the review The inclusion criteria were not stated, but it is likely that only one study had evaluated brief psychotherapy treatments for children.
Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Number of primary studies included One study was included (see Other Publications of Related Interest).
Methods of combining primary studies Investigation of differences between primary studies Results of the review The prevalence of mild behaviour problems was 24.9% for 1- to 3-year-old children and 24% for 4- to 7-year-old children. Behavioural improvements with psychotherapy treatment were reported for 74% of the children. No detail was given on the measure of treatment response.
Methods used to derive estimates of effectiveness It is likely that the authors made assumptions to estimate quality of life adjustments. The methods and values used were not stated.
Estimates of effectiveness and key assumptions Measure of benefits used in the economic analysis The measure of benefit was the quality-adjusted life-years (QALYs) gained using a simulation model. The valuation of health states was not stated.
Direct costs The costs were discounted at 5% per year. The length of follow-up was one year and 10 years. The costs and the quantities were not reported separately. The direct costs were for screening, nurses' training, programmes to motivate physicians, and treatment. The method used to estimate the costs was reported. All the costs were expressed in 1991 values.
Statistical analysis of costs Indirect Costs The indirect costs were not reported.
Sensitivity analysis A one-way simple sensitivity analysis was carried out to investigate variability in the data. The variables considered were the number and duration of medical examinations, the proportion of qualified nurses, the discount rate and the prevalence of mild behaviour problems.
Estimated benefits used in the economic analysis The authors reported that, compared with the absence of medical care, the short-term psychotherapy programme resulted in 1.12 QALYs gained in perfect health at 5 years old and 3.87 QALYs gained at 15 years old. The QALYs gained in perfect health in the "control group" were 0.24 (5 years) and 0.84 (15 years), respectively.
Cost results The total cost at 5 years old was Can$210 in the "treatment group" versus Can$164 in the "control group". At 15 years old, the total costs were Can$203 (treatment) versus Can$364 (control).
Synthesis of costs and benefits A short-term psychotherapy programme provided an incremental cost of Can$52 per QALY gained at 5 years old. The incremental cost-effectiveness ratio was Can$ -44 per QALY gained at 15 years old. The sensitivity analysis only reported the influence of medical and cost parameters on the total cost, and not on the incremental cost-effectiveness ratio.
Authors' conclusions "Children treated for mild behaviour problems through short-term therapy at a very young age will benefit from a better quality of life." The costs sustained by the health care system were inferior to those for traditional treatments and care, which are commonly used for these types of problems.
CRD COMMENTARY - Selection of comparators The comparator for the economic analysis was justified because it represented current practice in the authors' country. You should decide if the comparator represents current practice in your own setting. However, the comparator for the effectiveness estimate was the absence of treatment and care programme, which was not stated clearly in the text.
Validity of estimate of measure of effectiveness The effectiveness was estimated from a U.S. study. It was unclear how the authors used these data to simulate a cohort of 452,795 children in a 10-year follow-up period. No effectiveness quantities were reported. Thus, it was not possible to assess whether relevant measures were considered.
Validity of estimate of measure of benefit The summary measure of benefit was the number of QALYs gained. However, it was unclear whether QALY adjustments were estimated from published studies, expert consensus or authors' assumptions. The authors did not report the method used to derive the utility values for QALY adjustments, but the final results. Thus, it was not possible to assess whether relevant adjustments were considered.
Validity of estimate of costs The authors did not report clearly whether the study was conducted from the perspective of the health care provider or society. No indirect costs were reported. The costs were derived from local community services data. The quantities were not reported separately. A sensitivity analysis conducted by the authors did not test the robustness of the results, but the impact of parameters on the total costs.
Other issues The authors did not report any limitations of the study. The methods used were extremely limited and were not explained in sufficient detail. Thus, there is uncertainty around the relevance of benefit estimates. The issue of generalisability to other settings was not addressed. The authors' conclusion was not justified and the discussion was rather limited. The study enrolled young patients with mild disease, but generalised conclusions concerning benefits across all age groups (in terms of prevention of violence, criminality and suicide) and future cost-savings (increase of productivity and decrease of health services uses) were made.
Implications of the study The results suggest improvements in quality of life and cost-savings can be achieved by the intervention. The authors extrapolated the results of this analysis in terms of future benefits and savings. However, additional studies would be needed to validate these results.
Bibliographic details Poinsier B, Laurin A S. Evaluation economique d'un programme simule de psychotherapie breve pour enfants presentant des troubles legers. [Economic evaluation of a simulated program of brief psychotherapy for children with mild problems] Sante Mentale au Quebec 1995; 20(2): 203-218 Other publications of related interest Finney J W, Riley A W, Cataldo M F. Psychology in primary health care: effects of brief targeted therapy in children's medical care utilization. Journal of Pediatric Psychology. 1991;16(4):447-61.
Indexing Status Subject indexing assigned by NLM MeSH Child Behavior Disorders /therapy; Child Psychiatry /economics; Child, Preschool; Cost-Benefit Analysis; Health Care Costs; Humans; Infant; Parents /psychology; Psychotherapy, Brief /economics; Quality of Life; Quebec; Severity of Illness Index AccessionNumber 21997006475 Date bibliographic record published 31/07/2003 Date abstract record published 31/07/2003 |
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