Economic Impact of the Statewide Implementation of an Evidence-Based Treatment: Multisystemic Therapy in New Mexico

Dopp, Alex R.; Coen, Anita Saranga; Smith, Allison; Reno, Jessica; Bernstein, David; Kerns, Suzanne E. U.; Altschul, Deborah

doi:10.1016/j.beth.2017.12.003

Cited by 24 publications

(14 citation statements)

References 29 publications

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“…We eliminated several checklist items that were not relevant for costing studies that did not also include an economic evaluation. We converted CHEERS checklist quality scores used in previous research [17,18] to a percentage. Previous studies applied the following scoring categories: excellent (24 out of 24 points or 100%), good (at least 18 out of 24 points or 75-99%), average (at least 12 out of 24 points or 50-74%), and poor (11 or fewer out of 24 points or 0-49%).…”

Section: Data Extraction and Analysismentioning

confidence: 99%

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

2021

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Background This study is a systematic literature review of cost analyses conducted within implementation studies on behavioral health services. Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Costing studies in this area are rare but necessary since cost can be a barrier to implementation and sustainment of EBP. Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and applied the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Key search terms included: (1) economics, (2) implementation, (3) EBP, and (4) behavioral health. Terms were searched within article title and abstracts in: EconLit, SocINDEX, Medline, and PsychINFO. A total of 464 abstracts were screened independently by two authors and reduced to 37 articles using inclusion and exclusion criteria. After a full-text review, 18 articles were included. Results Findings were used to classify costs into direct implementation, direct services, and indirect implementation. While all studies included phases of implementation as part of their design, only five studies examined resources across multiple phases of an implementation framework. Most studies reported direct service costs associated with adopting a new practice, usually summarized as total EBP cost, cost per client, cost per clinician, and/or cost per agency. For studies with detailed analysis, there were eleven direct cost categories represented. For five studies that reported costs per child served, direct implementation costs varied from $886 to $9470 per child, while indirect implementation costs ranged from $897 to $3805 per child. Conclusions This is the first systematic literature review to examine costs of implementing EBP in behavioral healthcare settings. Since 2000, 18 studies were identified that included a cost analysis. Given a wide variation in the study designs and economic methods, comparison across studies was challenging, which is a major limitation in the field, as it becomes difficult to replicate studies or to estimate future costs to inform policy decisions related to budgeting. We recommend future economic implementation studies to consider standard economic costing methods capturing costs across implementation framework phases to support comparisons and replicability.

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Section: Data Extraction and Analysismentioning

confidence: 99%

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

2021

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“…Cost savings can vary from state to state depending on local conditions. The estimated cost‐benefit ratio for MST statewide in New Mexico is $3.34 (Dopp et al., 2018), and in Colorado it is $3.00 (Colorado Office of State Planning and Budgeting, 2018). These cost‐benefit estimates include the initial start‐up costs for evidence‐based programs.…”

Section: Fidelity: the Practice Approachmentioning

confidence: 99%

Evidence‐based juvenile justice programs and practices: A critical review

Elliott

Buckley

Gottfredson

et al. 2020

Criminology & Public Policy

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There is growing critical commentary and debate about the relative effectiveness of individual program and generic practice approaches to identifying evidencebased interventions and their impact on the operation of the juvenile justice system. The central issue is whether both of these approaches to identifying evidence-based interventions provide a valid and reliable guide to improving juvenile justice programming and, if so, what are the relative advantages and disadvantages of each? From a public policy perspective, should we be investing more heavily in one or the other, or treating them as effective complementary approaches and encourage both? We address each of these questions and offer some suggestions for improving the effectiveness of each approach.

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“…Important MST outcomes such as recidivism and out-of-home placements can be regularly tracked at the local or state level to document success. Finally, economic evaluations estimate that MST produces over $3 in economic benefits per $1 spent within 2 years post-treatment [ 36 , 37 ].…”

Section: Case Examplesmentioning

confidence: 99%

“…Complex economic considerations limit availability of MST, despite strong evidence of its economic benefits from reduced recidivism and out-of-home placements [ 38 ]. For example, community-based behavioral health agencies that deliver MST pay up-front for implementation, often with support from juvenile justice partners, whereas Medicaid and adult criminal justice realize most of the eventual benefits from decreased arrests and out-of-home placements [ 36 ]. The per-patient costs of delivering MST are substantial, typically ranging from $8000–13,000 per 4–6 month treatment episode, as the intervention requires intensive services, small caseloads, and ongoing training, consultation, and quality assurance activities.…”

Section: Case Examplesmentioning

confidence: 99%

“…The substantial cost-benefit tradeoffs of MST were integral to supporting the financing arrangements for this project. Based on published evidence of >$3 for each dollar spent [ 36 , 37 ] and the state’s predicted 28% reduction in youth recidivism [ 39 ], state-level savings for this initiative were conservatively predicted at over $8 million across 3 years. Implementation costs were the primary barrier to MST dissemination in Colorado, and Pay-for-Success financing offered a viable strategy to raise the upfront capital, share risk across public and private investors, and enable agencies to establish sustainable MST teams that may continue to produce a return on investment in the years ahead.…”

Section: Case Examplesmentioning

confidence: 99%

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Translating economic evaluations into financing strategies for implementing evidence-based practices

et al. 2021

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Background Implementation researchers are increasingly using economic evaluation to explore the benefits produced by implementing evidence-based practices (EBPs) in healthcare settings. However, the findings of typical economic evaluations (e.g., based on clinical trials) are rarely sufficient to inform decisions about how health service organizations and policymakers should finance investments in EBPs. This paper describes how economic evaluations can be translated into policy and practice through complementary research on financing strategies that support EBP implementation and sustainment. Main body We provide an overview of EBP implementation financing, which outlines key financing and health service delivery system stakeholders and their points of decision-making. We then illustrate how economic evaluations have informed decisions about EBP implementation and sustainment with three case examples: (1) use of Pay-for-Success financing to implement multisystemic therapy in underserved areas of Colorado, USA, based in part on the strength of evidence from economic evaluations; (2) an alternative payment model to sustain evidence-based oncology care, developed by the US Centers for Medicare and Medicaid Services through simulations of economic impact; and (3) use of a recently developed fiscal mapping process to collaboratively match financing strategies and needs during a pragmatic clinical trial for a newly adapted family support intervention for opioid use disorder. Conclusions EBP financing strategies can help overcome cost-related barriers to implementing and sustaining EBPs by translating economic evaluation results into policy and practice. We present a research agenda to advance understanding of financing strategies in five key areas raised by our case examples: (1) maximize the relevance of economic evaluations for real-world EBP implementation; (2) study ongoing changes in financing systems as part of economic evaluations; (3) identify the conditions under which a given financing strategy is most beneficial; (4) explore the use and impacts of financing strategies across pre-implementation, active implementation, and sustainment phases; and (5) advance research efforts through strong partnerships with stakeholder groups while attending to issues of power imbalance and transparency. Attention to these research areas will develop a robust body of scholarship around EBP financing strategies and, ultimately, enable greater public health impacts of EBPs.

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Economic Impact of the Statewide Implementation of an Evidence-Based Treatment: Multisystemic Therapy in New Mexico

Cited by 24 publications

References 29 publications

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

Evidence‐based juvenile justice programs and practices: A critical review

Translating economic evaluations into financing strategies for implementing evidence-based practices

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