Økonomisk evaluering av behandling for ungdom med villet egenskade – hvorfor og hvordan?

Egil Haga, Berit Grøholt, Anita Johanna Tørmoen, Eline Aas, Lars Mehlum

Sammendrag


I studier av kostnadseffektivitet evaluerer man om behandlingskostnader står i et rimelig forhold til effekten. Gitt begrensede ressurser er slike studier viktige som beslutningsgrunnlag vedrørende implementering av nye behandlingsformer. I forbindelse med en intervensjonsstudie for ungdommer med repetert villet egenskade, der dialektisk atferdsterapi for ungdom (DBT-A) sammenlignes med standard behandling, planlegges det å gjøre en økonomisk evaluering. Formålet med denne artikkelen er å gjøre rede for metoden for evaluering av kostnadseffektivitet, samt belyse rasjonalet for en slik evaluering. Eksisterende forskning peker i retning av at ungdommer med repetert selvskading har et stort forbruk av helsetjenester, men at det er lite kunnskap om hvorvidt behandlingen som tilbys er kostnadseffektiv. Nylig publiserte resultater fra den nevnte intervensjonsstudien viste at DBTA var mer effektiv enn standard behandling etter en behandlingsperiode på 19 uker (Mehlum et al., 2014), samtidig som DBT-A medførte mer omfattende bruk av ressurser. I lys av dette synes det særlig relevant for beslutningstagere at DBT-A evalueres med henblikk på kostnadseffektivitet. Den endelige økonomiske evalueringen vil gjøres over en periode på til sammen 71 uker (behandlings- og oppfølgingsperiode) og vil basere seg på gjennomsnittlig totalkostnad per pasient (DBT-A vs. standard behandling) og effektanalyser. The aim of cost-effectiveness studies is to evaluate whether the costs of a new treatment are reasonable in relation to treatment effects. Given limited resources such studies are important for decision-makers when making priorities with respect to implementation of new treatments. Following an intervention study for adolescents with repeated deliberate self-harm, comparing dialectical behavior therapy for adolescents (DBT-A) with standard treatment, the costeffectiveness of DBT-A will be evaluated. The objective of this paper is to outline the method for evaluation of cost-effectiveness, as well as discussing the rationale for conducting a costeffectiveness study of DBT-A. Research indicates that adolescents with selfharm is a patient group with extensive use of health services, however, that the knowledge of cost-effectiveness of treatment is sparse. The intervention study showed that DBT-A was more effective than standard treatment after a treatment period of 19 weeks (Mehlum et al., 2014), but that DBT-A also lead to more use of outpatient resources. Thus, it appears highly relevant to evaluate the cost-effectiveness of DBT-A. The evaluation will be conducted over a period of 71 weeks (treatment and follow-up), and will be based on average total costs per patient (DBT-A vs standard treatment) and analyses of treatment effects.

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DOI: http://dx.doi.org/10.5617/suicidologi.2270