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

  • 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 wasBackground 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.show moreshow less

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Author:Michael Strupf, Andreas Hoell, Malek Bajbouj, Kerem Böge, Maren Wiechers, Carine Karnouk, Inge Kamp-Becker, Tobias Banaschewski, Andreas Meyer-Lindenberg, Michael Rapp, Alkomiet HasanORCiDGND, Peter Falkai, Ute Habel, Andreas Heinz, Paul Plener, Franziska Kaiser, Stefanie Weigold, Nassim Mehran, Aline Übleis, Frank Padberg
URN:urn:nbn:de:bvb:384-opus4-1058634
Frontdoor URLhttps://opus.bibliothek.uni-augsburg.de/opus4/105863
ISSN:2056-4724OPAC
Parent Title (English):BJPsych Open
Publisher:Cambridge University Press
Place of publication:Cambridge
Type:Article
Language:English
Year of first Publication:2023
Publishing Institution:Universität Augsburg
Release Date:2023/07/11
Tag:Psychiatry and Mental health
Volume:9
Issue:4
First Page:e113
DOI:https://doi.org/10.1192/bjo.2023.504
Institutes:Medizinische Fakultät
Medizinische Fakultät / Lehrstuhl für Psychiatrie und Psychotherapie
Nachhaltigkeitsziele
Nachhaltigkeitsziele / Ziel 10 - Weniger Ungleichheiten
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):CC-BY 4.0: Creative Commons: Namensnennung (mit Print on Demand)