Cost-effectiveness of a mental health drop-in centre for young people with long-term physical conditions

Abstract

Background Paediatric patients being treated for long-term physical health conditions (LTCs) have elevated mental health needs. However, mental health services in the community are difficult to access in the usual course of care for these patients. The Lucy Project – a self-referral drop-in access point—was a program to address this gap by enrolling patients for low-intensity psychological interventions during their treatment for LTCs. In this paper, we evaluate the cost-effectiveness of the Lucy Project. Methods Using a pre-post design, we evaluate the cost-effectiveness of the intervention by calculating the base-case incremental cost-effectiveness ratio (ICER) using outcomes data and expenses recorded by project staff. The target population was paediatric patients enrolled in the program with an average age of 9 years, treated over a time horizon of 6 months. Outcome data were collected via the Paediatric Quality of Life Inventory, which was converted to health utility scores using an instrument found in the literature. The QALYs were estimated using these health utility scores and the length of the intervention. We calculate a second, practical-case incremental cost-effectiveness ratio using streamlined costing figures with maximum capacity patient enrolment within a one-year time horizon, and capturing lessons learned post-trial. Results The base-case model showed an ICER of £21,220/Quality Adjusted Life Years (QALY) gained, while the practical model showed an ICER of £4,359/QALY gained. The practical model suggests the intervention garners significant gains in quality of life at an average cost of £309 per patient. Sensitivity analyses reveal use of staff time was the greatest determinant of the ICER, and the intervention is cost-effective 75% of the time in the base-case model, and 94% of the time in the practical-case model at a cost-effectiveness threshold of £20,000/QALY gained. Conclusions We find the base-case intervention improves patient outcomes and can be considered cost-effective according to the National Institute for Health and Care Excellence (NICE) threshold of £20,000—£30,000/QALY gained, and the practical-case intervention is roughly four times as cost-effective as the base-case. We recommend future studies incorporate a control group to corroborate the effect size of the intervention.

Efficient Sufficiency: A qualitative evaluation of a 1 year pilot study of young people and parents accessing a mental health drop‐in centre in a paediatric hospital

“…The majority of participants interviewed were mothers (27/35), limiting the extent to which our findings can be applied to fathers and young people. As discussed in more detail elsewhere (Bennett et al, 2021 ; Catanzano, Bennett, Kerry, et al, 2020 ; Clarke et al, 2022 ), the lack of control group is a limitation of the wider study, as improvements may have been due to time or other confounders. We did not use validated measures of service use, which would have captured use of all interventions/support outside the project, as it was felt that questionnaire burden was already high.…”

“…These findings, in conjunction with analysis of quantitative outcomes (Bennett et al, 2021 ; Catanzano, Bennett, Kerry, et al, 2020 ; Clarke et al, 2022 ) and the acceptability and feasibility of remotely delivered training (Batchelor et al, 2020 ), may be used to help guide the design and implementation of future randomized controlled trials evaluating the effectiveness of brief psychological treatments for young people with LTC. This may be done by, for instance, retaining a degree of flexibility in terms of scheduling appointments, using goal‐based outcomes and routine outcome monitoring as part of the intervention and offering brief CBT/guided self‐help.…”

“…A drop‐in centre in a paediatric hospital delivering brief cognitive behavioural interventions may be one way for more children to access evidence‐based treatments. This was the goal of the ‘Lucy project’: to evaluate the acceptability, feasibility and impact of a ‘Mental Health and Psychological Wellbeing Drop‐in Centre’ in a tertiary paediatric hospital setting (Catanzano et al, 2021 ) and the quantitative outcomes are reported elsewhere (Bennett et al, 2021 ; Catanzano, Bennett, Kerry, et al, 2020 ; Clarke et al, 2022 ). The project was an uncontrolled trial of young people, their siblings and carers attending a national paediatric hospital.…”

Implementing brief and low-intensity psychological interventions for children and young people with internalizing disorders: a rapid realist review

“… 5 There is evidence that brief and low-intensity interventions are as efficacious for children and young people with anxiety and depression as standard face-to-face interventions 6 and preliminary evidence of their cost-effectiveness. 7 …”

“… 8 Shorter duration interventions can be more readily and widely deployed, increasing access to treatment and reductions in therapist contact time can be less costly to health service providers. 7 These interventions can be utilized as part of a ‘stepped care approach’, using CBT with minimal therapist assistance as a first line of treatment and then ‘stepping up’ care to therapist-directed treatment to address individualized client needs for those requiring additional treatment. Stepped care interventions are therefore designed to maximize resources by providing lower intensity and less costly approaches as a first line treatment.…”