Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial)

Abstract

IntroductionChildren who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK.Methods and analysisAn economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)–Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost–utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective).Ethics and disseminationEthics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme).Trial registration numberNCT02653716; Pre-results.

A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT

“…To compensate for this limitation, we used a published algorithm to map health state utilities from clinical outcomes using the SDQ. Mapping is a widely used approach in economic evaluation where direct measurement of health utilities is not possible, [83][84][85] and is recommended by NICE and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). 65,86 However, the validity of the methods used is debated in the literature, [87][88][89] loss of information at each stage of transformation leads to uncertain estimates and thus potentially erroneous conclusions, and proxy reporting by parents is also associated with a number of limitations.…”

A framework for conducting economic evaluations alongside natural experiments

“…A focus on unidimensional outcomes may be too narrow in PHIs where a battery of multi-sector outcomes may be relevant for inclusion, using a broader societal perspective including benefits to patients, carers and the whole society. For example, PHIs aimed at improving infant mental health result in long term improvements in infant health, educational attainment and employment prospects (Deidda et al, 2018)). This justifies collecting a wide range of outcomes, and the use of broader evaluation frameworks such as cost-benefit analysis (CBA) (Tudor Edwards and McIntosh, 2018), cost-consequence analysis (CCA) (as recommended by the NICE public health economic evaluation guidance) or multi-criteria decision analysis (Marsh et al, 2016) (MCDA).…”

“…Within the complex framework of PHIs and NEs, an economic evaluation logic model (NICE, 2014) represents a useful tool to describe anticipated causal pathways and inter-relationships of resource use and outcomes, providing guidance the choice of data collection identifying the behaviour change induced by the intervention, the factors that exert influence on program effectiveness and cost-effectiveness at different levels (individual, social, group level)(e.g. (Deidda et al, 2018).…”

Going beyond the mean in examining relationships of adolescent non-cognitive skills with health-related quality of life and biomarkers in later-life

“…This implication is becoming increasingly important as policy moves towards more complex public health interventions ( Schonert-Reichl et al, 2012 ; Baba et al, 2017 ). Evaluations of these interventions are beginning to recognise the role of non-cognitive skills as an instrument through which health can be improved ( Craig et al, 2006 ; Deidda et al, 2018 ). The evidence presented here emphasises the importance of their inclusion in such evaluations.…”