title: Cost-effectiveness of multidimensional family therapy compared to cognitive behavioral therapy for adolescents with a cannabis use disorder: Data from a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of Multidimensional Family Therapy (MDFT) for adolescents with a cannabis use disorder, compared to Cognitive Behavioural Therapy (CBT).
  
  
  METHODS
  A parallel-group randomized controlled trial was performed. 109 adolescents with a DSM-IV cannabis use disorder (CBT n=54; MDFT n=55) were included. Assessments were conducted at baseline, and 3, 6, 9 and 12 months post-baseline, and included measures on cannabis and other substance use, delinquency, health care utilization, and general health related quality of life.
  
  
  RESULTS
  Excluding those with missing cost-data, 96 participants (MDFT n=49; CBT n=47) were included. From a health care perspective, the average annual direct medical costs in the CBT group were €2015 (95%C.I. 1397-2714), compared to €5446 (95%C.I. 4159-7092) in the MDFT group. The average quality-adjusted life years (QALY's) gained were 0.06 QALY higher for the MDFT group, which led to an incremental cost-effectiveness ratio (ICER) of 54,308 Euro/QALY or €43,405 per recovered patient. Taking the costs of delinquency into account, the costs increased to €21,330 (95%C.I. 12,389-32,894) for the CBT group and to €21,915 (95%C.I. 16,273-28,181) for the MDFT group, which lead to an ICER of 9266 Euro/QALY or a cost per recovered patient of €7491.
  
  
  CONCLUSIONS
  This is the first comprehensive CEA of MDFT compared to CBT and it demonstrated that when costs of delinquency were included, the ICERS were modest. The results underline the importance of adopting a broader perspective regarding cost effectiveness analyses in mental health care.
authors.affiliation: Institute for Medical Technology Assessment & Institute of Health Policy & Management, P.O. Box 1738, 3000 DR, Erasmus University Rotterdam, The Netherlands. Electronic address: Goorden@bmg.eur.nl.
authors.forename: M
authors.initials: M
authors.lastname: Goorden
authors.affiliation: Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Group, P.O. Box 53002, 2505 AA The Hague, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van der Schee
authors.affiliation: Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Group, P.O. Box 53002, 2505 AA The Hague, The Netherlands; Curium, Leiden University Medical Center, Department of Child and Adolescent Psychiatry, Leiden University, P.O. Box 37, 2300 AA Leiden, The Netherlands.
authors.forename: V M
authors.initials: VM
authors.lastname: Hendriks
authors.affiliation: Institute for Medical Technology Assessment & Institute of Health Policy & Management, P.O. Box 1738, 3000 DR, Erasmus University Rotterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Hakkaart-van Roijen
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005196:Family Therapy / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007604:Juvenile Delinquency / Q000191:economics; D008297:Male; D002189:Marijuana Abuse / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: Adolescents; CBT; Cannabis use disorder; Cost-effectiveness; Delinquency; ISRCTN00179361; MDFT