Background. In the Netherlands municipalities are responsible for the organization of youth care and for decisions regarding the purchase of interventions. The effectiveness and cost-effectiveness of available interventions are therefore of importance to inform policy making. Cost-effectiveness has received even more emphasis, due to the reorganization in the policies concerning Dutch youth care.
Although knowledge about effectiveness of interventions is considerable, knowledge about cost-effectiveness of these interventions seems to be limited. Studies on cost-effectiveness of interventions - in which the differences in effects and costs between two or more interventions are evaluated - provide information whether the intervention of interest would be preferred compared to a comparative intervention.
Objective. A systematic literature review was performed to evaluate the current knowledge about cost-effectiveness of interventions in youth care in the Netherlands and to assess the quality of the economic evaluations. The literature review focused on psychosocial, preventive interventions for physical, social, cognitive or psychiatric developmental disorders or the (pharmaceutical) treatment of psychosocial and psychiatric disorders of the child.
Methods. Medline (Pubmed), Centre for Reviews and Dissemination Database, and PsycINFO were searched, complemented with specific Dutch databases. Completed, ongoing and planned studies were included. Information about characteristics of all included studies was collected by one researcher and checked by a second researcher on specific items. In addition, completed, full economic evaluations were assessed on their methodological quality with the Consensus on Health Economics Checklist (CHEC) - Extended by two researchers. The CHEC-Extended consists of characteristics of economic evaluations that determine whether the results of a cost-effectiveness analysis are methodologically sound. Examples of these characteristics are the perspective taken, which determines the costs that are included in the analysis; how the amount of costs and effects are measured and valued; whether sensitivity analyses are performed to assess the robustness of the results; and whether the conclusion is based on the results.
Results. In total, 47 studies were identified in this literature review. Of these, 18 studies were completed, full economic evaluations and where assessed on their methodological quality. Another three studies were cost-analysis studies, 10 studies described the study design in a scientific article, and 16 studies were found that had not published their design or results in a scientific journal. There was large heterogeneity in the study populations and interventions that were evaluated. Examples of study populations are children with anxiety (n=6), behavioral problems such as aggression or criminal behavior (n=6), ADHD (n=4), obesity (n=2) and children in the general population (n=9). Often evaluated interventions are cognitive behavioral therapy and interventions that focus on the child’s primary caregivers or his/her whole system. Conclusions about the cost-effectiveness of the studied interventions differed across the types of intervention. Most of the completed, full economic evaluations scored above 70% (n=15) of the maximum number of points for methodological quality. Seven of these studies scored above 80% and could therefore be considered as examples of good quality economic evaluations. In general, the items on which some studies could improve were precise formulation of the research question, descriptions of the interventions compared, the measurement of the amount of resources used and methods for calculating costs, performing elaborate sensitivity analyses and disclosing conflict of interests.
Conclusions. The current knowledge about the cost-effectiveness of interventions in youth care is limited with only 18 studies published in scientific journals, while this knowledge is important for decision making regarding the allocation of scarce resources. We note that the extra investments of performing a good quality economic evaluation alongside an RCT are relatively low. Not collecting data about resource use in an RCT studying the effectiveness of interventions is a missed opportunity.
