Evidence map›Paper›PMID 26345320›Full record

Trial reportHealth policy and planning2016

Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial.

Ryan K McBain, Carmel Salhi, Katrina Hann, Joshua A Salomon, Jane J Kim, Theresa S Betancourt

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Health policy and planning, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  19. Patterns, trends and methodological associations in the measurement and valuation of childhood health utilities.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2019
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Ryan K McBainDepartment of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA, Research Center on Children and Global Adversity, FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA and rmcbain@hsph.harvard.edu.
Carmel SalhiDepartment of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA.
Katrina HannResearch Center on Children and Global Adversity, FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA and.
Joshua A SalomonDepartment of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA.
Jane J KimDepartment of Health Policy and Management, Harvard School of Public Health, 617 Huntington Avenue, 7th, Boston, 02115 MA, USA.
Theresa S BetancourtDepartment of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA, Research Center on Children and Global Adversity, FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA and.

Funding

The Center for the Global Demography of AgingP30AG024409 · NIA · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI BLOOM, DAVID E · 2004 to 2019
$7.9M
Modifiable Protective Processes in the Mental Health of Refugee ChildrenK01MH077246 · NIMH · HARVARD SCHOOL OF PUBLIC HEALTH · PI BETANCOURT, THERESA STICHICK · 2008 to 2012
$850k
Evaluation of a Community-Based Psychosocial Intervention for War-Affected YouthF31MH097333 · NIMH · HARVARD SCHOOL OF PUBLIC HEALTH · PI MCBAIN, RYAN K · 2012 to 2013
$53k
NIA NIH HHS 5P30AG024409-08NIA NIH HHS P30 AG024409NIMH NIH HHS 1F31MH097333-01A1NIMH NIH HHS 5K01MH077246-05
6 · The paper itself

Abstract

backgroundOne billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis.

methodsThe Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline.

resultsRetention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained.

conclusionsThe YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials.

trial registrationclinicaltrials.gov Identifier: RPCGA-YRI-21003.

Indexed as

Health Care CostsWarfareAdolescentCost-Benefit AnalysisFemaleHumansMaleMental Health ServicesPsychotherapy, GroupSierra LeoneStress, PsychologicalTreatment OutcomeYoung AdultCost-effectiveness analysisdisabilitymental healthschoolsub-Saharan Africawar

Identifiers

PMID26345320
PMCPMC5007601

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.