Introduction – Stakeholders are increasingly interested in the societal impact of psychosocial interventions in the youth sector, in terms of costs and quality of life, next to outcomes research. As a result, there is an... [ view full abstract ]
Introduction – Stakeholders are increasingly interested in the societal impact of psychosocial interventions in the youth sector, in terms of costs and quality of life, next to outcomes research. As a result, there is an increasing attention for economic evaluations in the field of youth. Methods and instruments which are used in economic evaluations have however traditionally been developed for the somatic (health) care and moreover for an adult population, making it challenging to perform economic evaluations in the sector youth.
Objective – The aim of this broad consultation is to reach consensus regarding the steps which have to be undertaken, in order to set a research agenda which will lead to further methodological development and standardization of economic evaluations in the sector youth.
Method – The broad consultation consisted of an 8 step procedure, including the conceptualization of a consultation document consisting of a scoping review of (mainly) international opinion literature and an inventory of existing Dutch guidelines and manuals for economic evaluation, a written consultation procedure among a broad range of stakeholders; and a consultation meeting with these stakeholders. In the consultation document, the methodological issues and challenges emerging from the scoping review, as well as potential solutions for these issues and challenges offered by existing guidelines and manuals, have been categorized by framing aspects. In the written consultation procedure and in the consultation meeting, stakeholders have been asked to rank a maximum of the ten most important methodological issues and challenges for economic evaluations in the sector youth in order of importance, and to provide possible solutions or directions for research.
Results –In total 21 documents (18 articles, 1 white paper, 2 conference proceedings) were included in the scoping review. A total of 22 stakeholders have participated in the written consultation procedure and another 21 stakeholders have participated during the consultation meeting.
The methodological issues and challenges which were ranked top 5 by the stakeholders are 1) outcome measurement, 2) outcome identification, 3) cost valuation, 4) outcome valuation, and 5) time horizon / analytical approach. The existing guidelines and manuals provided guidance for some, but not all, issues and challenges. For the outcome side of the economic evaluation normative questions have been posed such as: what is the goal of psychosocial care for youth which the outcome(s) should comply with, and whose values count when obtaining preference weights for the outcome? Furthermore, respondents urged that they needed instruments specifically developed for youth to perform economic evaluations, such as instruments to measure costs, preference based instruments to measure quality of life , and cost prices (for education, social care, and justice).
For other methodological challenges overall consensus has been revealed, which are in line with the existing guidelines. For instance, regarding the perspective most stakeholders agreed on that economic evaluations should be, in principle, performed from the broad societal perspective, and regarding the type of economic evaluation that the cost-utility analysis is preferred. For the time horizon the stakeholders agreed that a long term time horizon is needed, but that in order to do so, more research is needed looking at the relationship between intermediate short term outcomes and long term final outcomes.
Discussion – This broad consultation has led to a research agenda which will in the long run lead to the standardization and methodological improvement of economic evaluations in the sector youth.
