Background This study aimed to investigate the health and economic outcomes of a universal early intervention for parents and children, the Salut Programme, from birth to when the child completed five years of age. Methods This study adopted a retrospective observational design using routinely collected register data with respect to both exposures and outcomes from a county in northern Sweden. Areas that received care-as-usual (non-Salut area) were compared to areas where the Programme was implemented after 2006 (Salut area) in terms of: i) health outcomes, healthcare resource use and related costs around pregnancy, delivery and birth, and ii) healthcare resource use and related costs, as well as costs related to care of sick child. Costs were estimated for inpatient care and specialised outpatient care for mothers and children. Two analyses were conducted: a matched difference-in difference analysis using the total sample and an analysis including a longitudinal subsample. Results The longitudinal analysis on mothers who had given birth in both the pre- and post-measure periods showed that those that had been exposed to the Salut Programme, had on average 6% (95% CI 3-9%) more full-term pregnancies and 2% (95% CI 0.03-3%) more babies born within normal weight range, compared to mothers who had only care-as-usual. Savings were incurred in terms of outpatient care related costs for children of mothers in the Salut area ($826). The difference-in-difference analysis using the total sample did not result in any significant differences in health outcomes or cumulative resource use over time. Conclusions The Salut Programme achieved health gains at a reasonable cost for children and parents, and may lead to lower usage of outpatient care. Other indicators point towards positive effects but the small sample size may have led to underestimation of true differences. The current findings support the continuous investment in this early childhood programme. Key messages • The Salut Programme improves the health of children and parents at a low cost. • The Salut Programme as a health promotion early intervention is value for money and should be included in the local policy investment agenda.
Background Up to 7% of the Swedish population meets criteria for harmful use or alcohol dependency but only 10-20% seek treatment. One of the most recommended psychological treatments for controlled drinking is Motivational Enhancement Therapy (MET). Behavioural Self-Control Training (BSCT) is another treatment that is unique in that it is based on the psychology of learning and specifically focused on skills training. To our knowledge, no previous studies exist that evaluated the cost-effectiveness of BSCT for alcohol use disorders (AUD). The aim of this study is to assess the cost-effectiveness of BSCT compared to MET for patients with AUD aiming for controlled drinking over the longer-term from a societal perspective. Methods We modelled a cohort of patients with AUD who aim for controlled drinking, over a 10 year time horizon, and estimated the expected costs and outcomes of BSCT and MET. The model reflects the epidemiological transitions between drinking states, which reflect different levels of daily alcohol intake. Each drinking state is connected to temporary or long-term complications attributable to alcohol consumption, different costs and utilities. The data was sourced from a randomized trial evaluating the effectiveness of MET vs BSCT. Risks for complications and associated costs, utilities and mortality were sourced from the literature. Results Compared to MET, BSCT resulted in less total QALYs gained (4,7 vs 6,6 QALYs per patient). MET remains a cost effective treatment compared to BSCT [incremental cost-effectiveness ratio (ICER) = SEK 8497,79 per gained QALY] and a No Intervention scenario BSCT [incremental cost-effectiveness ratio (ICER) = SEK 16321,07 per gained QALY] at a threshold of 500.000 SEK per QALY. Conclusions This study suggests that MET should remain the recommended treatment for AUD patients with a goal of controlled drinking in favor of BSCT. Key messages • Motivational Enhancement Therapy should remain the recommended treatment for AUD patients with controlled drinking as their goal. • A future study comparing Motivational Enhancemente Therapy to Behaivoral Self Control Training as recommended treatment in patients wanting to achieve abstinenece is suggested.
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