Shared sorrow, shared costs: cost-effectiveness analysis of the Empowerment group therapy approach to treat affective disorders in refugee populations

Abstract

Background Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions. Aims To evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms. Method This is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov. Results Health service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average €409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of €0 was €354.3 (€978.5 to −€269.9). Results were confirmed for different scenarios and varying WTP thresholds. Conclusions The Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU.

Videogestützte Psychotherapie für Geflüchtete: Eine Pilotstudie

“…Die Gruppenpsychotherapie Empowerment [14] wurde 2017 im Rahmen der multizentrischen Studie MEHIRA (Mental Health in Refugees and Asylum Seekers) an der Klinik für Psychiatrie und Psychotherapie der Universität München entwickelt und innerhalb eines gestuften Versorgungsmodells für Geflüchtete mit affektiven Erkrankungen implementiert [15,16]. In einer Stichprobe von 149 Geflüchteten zeigte die Intervention eine klinische Wirksamkeit [17], breite Anwendbarkeit [18] und Kosten-Effektivität [19] im Vergleich zur Routineversorgung (Treatment-as-usual). beim Ein-und Durchschlafen sowie Konzentrationsprobleme und Kopfschmerzen, häufig in Zusammenhang mit Lärm in der Gemeinschaftsunterkunft.…”