Table 2 Illustrative example: mixed-method cost-effectiveness evaluation of problematic sexual behavior-cognitive behavioral therapy
From: Mixed-method approaches to strengthen economic evaluations in implementation research
Section/item | No.a | CHEERS guideline | How met in illustrative example studyb |
|---|---|---|---|
Title and abstract | |||
Title | 1 | Identify the study as an economic evaluation. | Title: Economic value of community-based services for problematic sexual behaviors in youth: A mixed-method cost-effectiveness analysis. |
Abstract | 2 | Provide a structured summary of the study. | We note that design, interpretation of quantitative analyses were informed by qualitative themes; both themes, quantitative threshold indicated that results represented cost-effective values. |
Introduction | |||
Background and objectives | 3 | Provide an explicit statement of the broader context for the study. Present the study question and its relevance for health policy or practice. | Ability of treatments to reduce social, economic impacts of problematic sexual behavior is poorly understood. We used mixed-method cost-effectiveness analysis to compare costs of implementing PSB-CBT with clinical outcomes. |
Method | |||
Target population and subgroups | 4 | Describe characteristics of the base case population and subgroups analyzed. | 413 youth who received PSB-CBT at 1 of 6 provider agencies that implemented a PSB-CBT program between 2011 and 2015. We compared agencies that did vs. did not provide intensive individual services, did vs. did not incur indirect costs of implementation. |
Setting and location | 5 | State relevant aspects of the system(s) in which the decision(s) need(s) to be made. | Agencies received grants from U.S. OJJDP to implement PSB-CBT, achieved adequate fidelity. |
Study perspective | 6 | Describe the perspective of the study. | Perspective of agencies implementing PSB-CBT. |
Comparators | 7 | Describe the interventions or strategies being compared and state why they were chosen. | PSB-CBT: cognitive-behavioral treatment model, with concurrent groups for youth and caregivers. |
Time horizon | 8 | State and justify the time horizon(s) over which costs and consequences are evaluated. | Costs were measured for 6-month period. Outcomes were measured from 2011 to 2015. |
Discount rate | 9 | Report and justify the choice of discount rate(s) used for costs and outcomes. | N/A—all costs were measured within a period of less than one year (i.e., 6 months). |
Choice of health outcomes | 10 | Describe what outcomes were used as the measure(s) of benefit in the evaluation and their relevance for the study. | Caregiver-report measures of problematic sexual behaviors, nonsexual emotional and behavior problems (also self-reported), and traumatic stress symptoms. |
Measurement of effectiveness | 11a | Describe fully the design features of the effectiveness study. | Estimated pre-post changes in health outcome measures, expressed using effect size Cohen’s d. |
Estimating resources and costs | 13a | Describe approaches and data sources used to estimate and value resource use associated with the alternative interventions. | Collected quantitative cost surveys from participating agencies, covering costs related to running a PSB-CBT program. Cost survey was designed based on themes from qualitative interviews. |
Currency, price date, and conversion | 14 | Describe methods for adjusting estimated unit costs to a common currency and price date. | Converted all monetary values to 2017 U.S. dollars (national average). |
Analytic methods | 17 | Describe all analytical methods supporting the evaluation, including methods for handling population heterogeneity and uncertainty. | Calculated CERs as the per-youth cost of PSB-CBT divided by observed effect size for each health outcome. Compared CERs to a cost-effectiveness threshold of $8333. Used expertise plus qualitative themes to identify plausible range of values for key sources of uncertainty, variability; for sensitivity analyses, calculated CERs across those ranges of values. |
Results | |||
Study parameters | 18 | Report the values, ranges, references, and, if used, probability distributions for all parameters. Report reasons or sources for distributions used to represent uncertainty where appropriate. | Median cost of $3527. Large to moderate (ds = 0.72–1.99) improvements on health outcome measures. We conducted four sensitivity analyses (described under 20a and 21). |
Incremental costs and outcomes | 19 | For each intervention, report mean values for estimated costs and outcomes, as well as mean differences between the groups. If applicable, report incremental cost-effectiveness ratios. | CERs ranged from $1772 to $4899, indicating cost-effectiveness. Qualitative themes also indicated that PSB-CBT has valuable impact on families, society that is worth the cost. |
Characterizing uncertainty | 20a | Describe the effects of sampling uncertainty and methodological assumptions for the estimated incremental cost and effectiveness parameters. | Calculated CERs across plausible range for improvements on health outcome measures (95% CIs) and training costs (including vs. excluding initial training). All cost-effective except minimum improvement for traumatic stress. |
Characterizing heterogeneity | 21 | If applicable, report differences in costs, outcomes, or cost effectiveness explained by variations between subgroups. | Calculated CERs for agencies that did vs. did not provide intensive individual services, indirect costs. All cost-effective except for agency with regular supplemental individual services. |
Discussion | |||
Discussion | 22 | Summarize key study findings. Discuss limitations and generalizability of the findings; how the findings fit with current knowledge. | We note that the results of our qualitative interviews informed and supported the validity of our quantitative analyses. |