Are day-long psycho-educational workshops cost-effective? Eva-Maria - PowerPoint PPT Presentation

Are day-long psycho-educational workshops cost-effective? Eva-Maria Bonin, Jennifer Beecham

The intervention(s)  One-day CBT workshops to improve self- confidence in a community setting  Participants included in economic evaluation:  179 intervention (79%)  202 control (87%) 19/06/2014 2

Economic evaluation – methods Service use Costs Cost- effectiveness Outcomes 19/06/2014 3

Supports received by people with low self-confidence  CSRI (Beecham & Knapp, 2001)  3 months retrospective, self-reported measure  Comprehensive picture of service use  Hospital services  Primary care  Specialist mental health services  Social work  Counselling  Alternative therapy  Self-help  Third sector 19/06/2014 4

A look at selected services (bsln.) Service Number % Inpatient 28 7% Outpatient 103 27% A & E 34 9% GP 188 49% Psychologist 84 22% Psychiatrist 25 7% Psychotherapist 33 9% Counselling 80 21% Alternative therapy 60 16% Self-help 51 13% Charities and advice centres 30 8% Helplines 48 13% 19/06/2014 5

Support cost before the intervention - average £1,046 4% 2% 2% Hospital 50% Primary care 17% Mental health Social work 1% Counselling Self help Other services Medications 19% 5% 19/06/2014 6

Support costs at follow-up  No difference between intervention and control group  Intervention: £834 (incl. £161 intervention)  Control: £841 19/06/2014 7

Outcomes  Significant improvement in BDI  Significant improvement in RSES 19/06/2014 8

Economic evaluation - methods Service use Costs Cost- effectiveness Outcomes 19/06/2014 9

How the sausage is made  For each participant: NB = (WTP x outcome) - cost  What is the change in outcome?  What are the costs of achieving this outcome?  Question: How much is an improved outcome “worth”?  Putting the two together: Willingness to pay (WTP) and Net Benefit (NB)  The crucial question: Does the intervention lead to a higher Net Benefit? 19/06/2014 10

A simple example Participant Change in Costs WTP Net benefit BDI Peter +5 £150 £0 (0*5)-150= -150 Paul -3 £0 £0 (0*-3)-0= 0 Mary +8 £250 £0 (0*8)-250= -250 19/06/2014 11

Simple example cont. Participant Change in Costs WTP Net benefit BDI Peter +5 £150 £50 (50*5)-150= 100 Paul -3 £0 £50 (50*-3)-0= -150 Mary +8 £250 £50 (50*8)-250= 150 19/06/2014 12

Simple example cont. WTP Peter Paul Mary 0 -150 -0 -250 25 -25 -75 -50 50 100 -150 150 75 225 -225 350 100 350 -300 550 250 1100 -750 1750 500 2350 -1500 3750 1000 4850 -3000 7750 19/06/2014 13

Quick recap:  For each participant:  What is the change in outcome?  What are the costs of achieving this outcome?  Willingness to pay and Net Benefit  Does the intervention lead to a higher Net Benefit?  Calculate probability that Net Benefit is higher in the intervention group (confidence!)  Plot probability against WTP 19/06/2014 14

Beck Depression Inventory (BDI) Probability that intervention is cost-effective 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% £0 £20 £40 £60 £80 £100 £120 £140 £160 £180 £200 £220 £240 Value placed on improved outcomes (WTP) 19/06/2014 15

Rosenberg Self-Esteem Scale (RSES) Probability that intervention is cost-effective 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% £0 £20 £40 £60 £80 £100 £120 £140 £160 £180 £200 £220 £240 Value placed on improved outcomes (WTP) 19/06/2014 16

Conclusions  Intervention relatively cheap at £161  No associated increase in support costs  Likely to be cost-effective in terms of reducing self-confidence problems and BDI, but willingness-to-pay not firmly established  Good option to engage people who receive little in terms of other support, despite high level of distress  An accessible, acceptable, (cost-)effective option to include within IAPT 19/06/2014 17

Thank you! 19/06/2014 18

Beck Depression Inventory (BDI) Probability that intervention is cost-effective 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% £0 £20 £40 £60 £80 £100 £120 £140 £160 £180 £200 £220 £240 Willingness to pay Insomnia Self-confidence 19/06/2014 19

Specific outcome measures Probability that intervention is cost-effective 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% £0 £20 £40 £60 £80 £100 £120 £140 £160 £180 £200 £220 £240 Willingness to pay Insomnia (ISI) Self-confidence (RSES) 19/06/2014 20

Quality-adjusted life years (QALYs) Probability that intervention is cost-effective 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% £0k £5k £10k £15k £20k £25k £30k Willingness to pay Insomnia Self-confidence 19/06/2014 21