A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention – Family Therapy (SHIFT) trial

Cottrell, David; Wright-Hughes, Alexandra; Collinson, Michelle; Boston, Paula; Eisler, Ivan; Fortune, Sarah; Graham, Liz; Green, Jonathan; House, Allan; Kerfoot, Michael; Owens, David; Saloniki, Eirini-Christina; Simic, Mima; Tubeuf, Sandy; Farrin, Amanda

doi:10.3310/hta22120

Cited by 14 publications

(25 citation statements)

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“…Psychotropic medication costs were calculated using trial medication records. The intervention costs were calculated separately for each treatment arm using information on the type and duration of the therapies sessions available from the trial records [14,39].…”

Section: Self-harm Intervention: Family Therapy (Shift) Trial Case Studymentioning

confidence: 99%

“…Missing utility scores and total health and hospital services costs at 6 and 12 months were imputed using multiple imputations via chained equations [40][41][42]. Imputations were based on a number of demographic and clinical predictors; the process is described elsewhere [39]. Missing utility (4%) and clinical scores (3%) at baseline were not imputed.…”

Section: Self-harm Intervention: Family Therapy (Shift) Trial Case Studymentioning

confidence: 99%

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Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England

2018

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Objective This article presents alternative parental health spillover quantification methods in the context of a randomised controlled trial comparing family therapy with treatment as usual as an intervention for self-harming adolescents, and discusses the practical limitations of those methods. Methods The trial followed a sample of 754 participants aged 11-17 years. Health utilities are measured using answers to the EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L) for the adolescent and the Health Utility Index (HUI2) for one parent at baseline, 6 and 12 months. We use regression analyses to evaluate the association between the parent's and adolescent's health utilities as part of an explanatory regression model including health-related and demographic characteristics of both the adolescent and the parent. We then measure cost-effectiveness over a 12-month period as mean incremental cost-effectiveness ratios using various spillover quantification methods. We propose an original quantification based on the use of a household welfare function along with an equivalence scale to generate a health gain within the family to be added to the adolescent's quality-adjusted life-year gain. Results We find that the parent's health utility increased over the duration of the trial and is significantly and positively associated with adolescent's health utility at 6 and 12 months but not at baseline. When considering the adolescent's health gain only, the incremental cost-effectiveness ratio is £40,453 per quality-adjusted life-year. When including the health spillover to one parent, the incremental cost-effectiveness ratio estimates range from £27,167 per quality-adjusted life-year to £40,838 per quality-adjusted life-year and can be a dominated option depending on the quantification method used. Conclusion According to the health spillover quantification method considered, the incremental cost-effectiveness ratios vary from within the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold range to not being cost-effective.

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Section: Self-harm Intervention: Family Therapy (Shift) Trial Case Studymentioning

confidence: 99%

Section: Self-harm Intervention: Family Therapy (Shift) Trial Case Studymentioning

confidence: 99%

Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England

2018

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“…Of the 12 studies included, 66% were published after 2015. The studies were conducted mainly in Australia ( n = 5) [ 26 – 30 ] and the UK ( n = 3) [ 31 – 33 ] (Table 1 ). Most evaluations were related to anxiety and post-traumatic stress disorder (PTSD) ( n = 5) [ 26 , 27 , 31 , 32 , 34 ], followed by depression ( n = 3) [ 28 , 29 , 35 ] and anorexia nervosa ( n = 2) [ 30 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“… The target population was 11–18 year olds with anorexia nervosa Health care system Family-based treatment (FBT) compared to adolescent-focused individual therapy (AFT) No intervention Both cost and effects 3% Other 11 Cottrell DJ. et al, 2018 [ 33 ] UK Child and Adolescent Mental Health Services (CAMHS) across three English regions. Young people aged 11–17 years who had self-harmed at least twice presenting to CAMHS following self-harm.…”

Section: Resultsmentioning

confidence: 99%

“…The 6- and 12-month follow-ups) Costs estimated directly from the study data 2015/16 British pounds Change in Children’s Global Assessment Scale score 10 Le LK-D. et al, 2017 [ 30 ] Markov model 6 years Published literature and existing databases Intervention cost Disability weights Intervention and comparator efficacy, relapse and remission data 2013 Australian dollars DALYs averted Other mental health conditions 11 Cottrell DJ. et al, 2018 [ 33 ] Markov model Up to 5 years after randomization. Trial data and published literature Participant cost and utility data were available at 6, 12 and 18 months from the trial data and were directly included into the model to estimate longer-term costs and health benefits British pounds QALY gained 12 Freriks RD.…”

Section: Resultsmentioning

confidence: 99%

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Cost-effectiveness analysis of paediatric mental health interventions: a systematic review of model-based economic evaluations

Kularatna

Hettiarachchi

Senanayake

et al. 2022

BMC Health Serv Res

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Mental health disorders among children and youth are causing significant burden on health care systems. Hence, identifying cost-effective interventions is important for effective mental health care allocation. Although model-based economic evaluations are an essential component of assessing cost-effectiveness, evidence are limited in the context of child and youth mental health care. The objective was to systematically review the model-based economic evaluations of mental health interventions for children and youth.MethodsFour databases (MEDLINE, EMBASE, PsycINFO and Web of Science) were searched using appropriate search terms to retrieve model-based economic evaluations of mental health interventions for children and youth. The reporting quality of the included studies were appraised using the Consolidated health economic evaluation reporting standards (CHEERS) checklist.ResultsThe database search yielded 1921 records. Of the 12 selected for review, 66% were published after year 2015. Most of the studies were related to anxiety and post-traumatic stress disorder. There were eight cost-utility studies, three cost-effectiveness studies, and one study using both forms of analysis. Six studies used Markov models, three used decision trees, and three studies used both types of models. However, the model structure, health states, time horizon, and economic perspective showed wide variation. The reporting quality of the included studies varied from 91 to 96%.ConclusionModel based mental health economic evaluations among children and youth are increasingly being reported in recent research. The included studies used Markov models and decision trees, either alone or in combination, and the majority of the articles were of good reporting quality.

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Screening for Depression and Suicide Risk in Children and Adolescents

Viswanathan

Wallace

Middleton

et al. 2022

JAMA

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ImportanceDepression, suicidal ideation, and self-harm behaviors in youth are associated with functional impairment and suicide.ObjectiveTo review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force (USPSTF).Data SourcesPubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022.Study SelectionEnglish-language, randomized clinical trials (RCTs) of screening for depression or suicide risk; diagnostic test accuracy studies; RCTs of psychotherapy and first-line pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms.Data Extraction and SynthesisTwo reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.Main Outcomes and MeasuresTest accuracy, symptoms, response, remission, loss of diagnosis, mortality, functioning, suicide-related events, and adverse events.ResultsTwenty-one studies (N = 5433) were included for depression and 19 studies (N = 6290) for suicide risk. For depression, no studies reported on the direct effects of screening on health outcomes, and 7 studies (n = 3281) reported sensitivity of screening instruments ranging from 0.59 to 0.94 and specificity from 0.38 to 0.96. Depression treatment with psychotherapy was associated with improved symptoms (Beck Depression Inventory pooled standardized mean difference, −0.58 [95% CI, −0.83 to −0.34]; n = 471; 4 studies; and Hamilton Depression Scale pooled mean difference, −2.25 [95% CI, −4.09 to −0.41]; n = 262; 3 studies) clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (relative risk, 1.73 [95% CI, 1.00 to 3.00; n = 395; 4 studies). Pharmacotherapy was associated with improvement on symptoms (Children’s Depression Rating Scale–Revised mean difference, −3.76 [95% CI, −5.95 to −1.57; n = 793; 3 studies), remission (relative risk, 1.20 [95% CI, 1.00 to 1.45]; n = 793; 3 studies) and functioning (Children’s Global Assessment Scale pooled mean difference, 2.60 (95% CI, 0.78 to 4.42; n = 793; 3 studies). Other outcomes were not statistically significantly different. Differences in suicide-related outcomes and adverse events for pharmacotherapy when compared with placebo were not statistically significant. For suicide risk, no studies reported on the direct benefits of screening on health outcomes, and 2 RCTs (n = 2675) reported no harms of screening. One study (n = 581) reported on sensitivity of screening, ranging from 0.87 to 0.91; specificity was 0.60. Sixteen RCTs (n = 3034) reported on suicide risk interventions. Interventions were associated with lower scores for the Beck Hopelessness Scale (pooled mean difference, −2.35 [95% CI, −4.06 to −0.65]; n = 644; 4 RCTs). Findings for other suicide-related outcomes were mixed or not statistically significantly different.Conclusion and RelevanceIndirect evidence suggested that some screening instruments were reasonably accurate for detecting depression. Psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.

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A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention – Family Therapy (SHIFT) trial

Abstract: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in ; Vol. 22, No. 12. See the NIHR Journals Library website for further project information.

Cited by 14 publications

References 114 publications

Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England

Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England

Cost-effectiveness analysis of paediatric mental health interventions: a systematic review of model-based economic evaluations

Screening for Depression and Suicide Risk in Children and Adolescents

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