title: Cost-effectiveness of multisystemic therapy versus usual treatment for young people with antisocial problems.
abstract: BACKGROUND
  Behavioural problems are common among adolescents. The burden on society in social disturbance, health, failures to contribute and costs has triggered innovative community-based interventions such as multisystemic therapy (MST).
  
  
  OBJECTIVE
  Our aim was to compare the cost-effectiveness of MST and treatment as usual (TAU).
  
  
  METHODS
  Cost-effectiveness was assessed alongside a randomised clinical trial. One hundred and sixteen adolescents were allocated to MST or TAU. Follow-up lasted six months. Quality of life (EQ-5D) as perceived by the adolescents was the primary outcome. A societal perspective was used for cost assessment.
  
  
  RESULTS
  There was no significant difference between groups in the small improvement experienced in quality of life (EQ-5D average score improvement in both 0.02 points, standard deviation 0.13 MST; 0.23 TAU). Dropout before follow-up was 48% and 69% respectively. Overall costs attributed to these young people were, however, 50% lower in the MST group. The incremental cost-effectiveness ratio (ICER) was 384,633€ (95% CI: -2,001,433 to 2,024,681€), which indicates dominance of MST over TAU.
  
  
  CONCLUSIONS
  Our study shows that, at worst, MST offers no advantage to young offenders in terms of their experienced quality of life, but 'TAU' included family focused intervention as well as standard supervision. There were some cost advantages for the individual and his/her family in the MST group, but substantial cost benefits for wider society. The case for a large, multi-centre, perhaps international trial is strong as widespread implementation of MST would benefit everyone if these findings are confirmed. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Vermeulen
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Daniëlle E M C
authors.initials: DE
authors.lastname: Jansen
authors.affiliation: Department of Special Needs Education and Youth Care, University of Groningen, The Netherlands.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Knorth
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
mesh_terms: D000293:Adolescent; D000987:Antisocial Personality Disorder / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy / Q000191:economics* / Q000379:methods; D002648:Child; D003156:Community Mental Health Services; D003362:Cost-Benefit Analysis; D005190:Family; D005260:Female; D006801:Humans; D007604:Juvenile Delinquency / Q000523:psychology; D008297:Male; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires