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Table 4 Studies considering externalizing disorders and delinquency

From: The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review

Studies considering both costs and effects
Sheidow (2004) [23]   Costs intervention (MST)
 Medicaid (government insurance program) costs (inpatient, Outpatient, Pharmacy, other costs), Other treatment costs paid for by study
 MST
 Medicaid costs: 0-end treatment (4 months): €9,311 (±7,755)
 Medicaid costs: End treatment-12 months: €13,237 (±15,144)
 Other treatment costs paid for by study: €11,617
Costs comparator (CAU)
 Medicaid (government insurance program) costs (inpatient, Outpatient, Pharmacy, other costs), Other treatment costs paid for by study
 CAU
 Medicaid costs: 0-end treatment (4 months): €13,255 (±5,762)
 Medicaid costs: End treatment-12 months: €15,207 (±18,485)
 Other treatment costs paid for by study: €0
Difference costs (CostsCAU-CostsMST) (after risk adjusted model):
 0-end treatment (total costs):
 End treatment- 12 months post-treatment (total costs):
-€ 1,828
-€452 (SE = 14)
Effects intervention
 CBCL: Externalizing scores, internalizing scores:
 GSI: Global severity index are measures
 The main effects were not showed in this study but only differences over time were presented.
Effects comparator
 CBCL: Externalizing scores, internalizing scores:
 GSI: Global severity index
 The main effects were not showed in this study but only differences over time were presented.
Difference effects (EffectsCAU-EffectsMST) (after risk adjusted model):
 0-end treatment:
 end treatment- 12 months post-treatment:
Externalizing:-14.75 (SE = 8.37)
Internalizing:-14.19 (SE = 9.26)
Global severity index: −0.03 (SE = 0.497)
Externalizing:3.29 (SE = 9.97)
Internalizing:-6.18 (SE = 9.67)
Global severity index: −0.37 (SE = 0.428)
Results ICER: 1 point improvement in externalizing scores for usual care was associated with a cost of €1,561. 1 point improvement in externalizing scores for MST was associated with a costs of €404. After 12 months both treatments have comparable costs and externalizing scores.
Studies considering costs and benefits
Olsson4 (2010) [26] Costs intervention (MST)
 Treatment costs: € 10.789
 Travel: € 53 (133)
Costs comparator (CAU)
 Travel: €151 (225)
Benefits intervention (MST)
 Psychosocial and behavioral effects: −
 Social services (placement): € 31.947 (€65.869)
 Social services (nonplacement): € 8.557 (19.459)
 National board of institutional care (rebate): € 3.009 (11.014)
 National board of institutional care (placements): € 3.593 (31.937)
 Wider societal costs and benefit: set to zero
 Psychosocial and behavioral effects: set to zero
Benefits comparator (CAU)
Program effects
Social services (Placement): € 36.707 (73.407)
Social services (nonplacement): € 14.914 (15.405)
National board of institutional care (rebate): € 2.375 (9.949)
National board of institutional care (placements): 0 (0) SEK
Wider societal costs and benefit: set to zero
  Results The net loss to society after two years is € 4.555
Cary (2013) [28] Costs interventions (MST + YOT)
 Treatment costs:€ 3.013 (1.940)
 Social worker: € 733 (446)
 Reparation worker: € 100 (131)
 Drugs worker: € 54 (74)
 Connexions worker: € 33 (69)
 Parenting worker: € 36 (137)
 Group worker: € 17 (34)
 Psychologist: € 17 (67)
 Other appointments:€ 20 (59)
Costs comparator (YOT)
 Social worker: € 1.023 (779)
 Reparation worker: € 83 (14)
 Drugs worker: € 78 (152)
 Connexions worker: € 18 (61)
 Parenting worker: € 90 (182)
 Group worker: € 22 (44)
 Psychologist: € 30 (91)
 Other appointments: € 26 (95)
Benefits interventions (MST + YOT) Benefits comparator (YOT)
Offending behavior (Young offender information system):
 € 12,397 (18 472)  € 15,409 (24,013)
  Results Difference (Costs + benefits) between treatments € 1.612 (95 % C.I-€ 7.699-€ to 10.924)
In the cost-effectiveness plane, we see, there is 63 % probability that the net benefit of MST + Yot is positive in favor of the MST + YOT group.
Dopp (2014) [30] Costs interventions (MST)
Costs per patient: € 9,756
Costs comparator (CAU)
Costs per patient: € 1,843
Benefits intervention (MST) Benefits comparator (IT)
 Benefits for taxpayer
 Murder: € 0
 Sexual offenses: € 922
 Robbery: € 188
 Assault: € 1.156
 Property: € 2.395
 Drug: € 916
 Theft: € 131
 Stolen property: € 24
 Fraud: € 259
 Assault: € 236
 Drug: € 777
 TOTAL: € 7.007
 Benefits for taxpayer
 Murder: € 0
 Sexual offenses: € 602
 Robbery: € 308
 Assault: € 1.697
 Property: € 1.899
 Drug: € 1.334
 Theft: € 188
 Stolen property: € 53
 Fraud: € 224
 Assault: € 294
 Drug: € 598
 TOTAL: € 7.197
  Results Crime victim avoided expenses
 Murder/manslaughter
 Tangible: € 6.125
 Intangible: € 11.365
 Sexual
 Tangible: € 259
 Intangible: € 3.439
 Robbery
 Tangible: € 575
 Intangible: € 1.422
 Assault
 Tangible: € 539
 Intangible: € 2.926
 Property
 Tangible: € 3.914
 Intangible: € 0
 Drug
 Tangible: € 0
 Intangible: € 0
 TOTAL
 Tangible: € 11.412
 Intangible: € 19.151
Net present values and benefit-cost ratios
 Net present value
 Referred youths
 Taxpayer: € 2.348
 Crime victim tangible: € 2.389
 Crime victim intangible € 9.375
 Cumulative: € 29.939
 Siblings:
 Taxpayer: € 674
 Crime victim tangible: € 2.702
 Crime victim intangible: € 4.533
 Cumulative: € 6.561
 Sibling pairs
 Taxpayer: € 1.399
 Crime victim tangible: € 3.499
 Crime victim intangible: € 11.238
 Cumulative*: € 31.962
 *: Includes the incremental costs of MST over IT
 Benefit cost ratio
 Referred youths
 Taxpayer: 1.3
 Crime victim tangible: 1.3
 Crime victim intangible 2.19
 Cumulative: 4.78
 Siblings:
 Taxpayer: -
 Crime victim tangible: -
 Crime victim intangible: -
 Cumulative: -
 Sibling pairs
 Taxpayer: 1.18
 Crime victim tangible: 1.44
 Crime victim intangible: 2.42
 Cumulative*: 5.04
 *: Includes the incremental costs of MST over CAU
Sensitivity analysis
Max (plausible) values
Crime victim intangible benefits: € 48.087
Sibling juvenile arrest rates: € 30.74
Discount rates: € 24.063
Min (plausible) values
Crime victim intangible benefits: € 17.561
Sibling juvenile arrest rates:-
Discount rates: € 36.704
Borduin (2015) [31]    Costs interventions (MST-PSB)
 Costs per patient: € 10,566
 Costs comparator (CAU)
 Costs per patient: €4,610
Benefits intervention (MST-PSB)
 Benefits for taxpayer
 Murder: € 0
 Sexual offenses: € 6.419
 Robbery: € 2.189
 Assault: € 0
 Property: € 2.831
 Drug: € 1.899
 Theft: € 180
 Stolen property€ 0
 Fraud: € 91
 Assault: € 250
 Drug: € 512
 TOTAL: € 14.371
Benefits comparator (CAU)
 Benefits for taxpayer
 Murder: € 0
 Sexual offenses: € 15.756
 Robbery: € 0
 Assault: € 2.194
 Property: € 3.790
 Drug: € 518
 Theft: € 65
 Stolen property: € 39
 Fraud: € 75
 Assault: € 289
 Drug: € 112
 TOTAL: € 22.839
  Crime victim avoided expenses
 Murder/manslaughter
 Tangible: € 41.048
 Intangible: € 76.169
 Sexual
 Tangible: € 1.739
 Intangible: € 23.044
 Robbery
 Tangible: € 3.850
 Intangible: € 9.529
 Assault
 Tangible: € 3.612
 Intangible: € 19.611
 Property
 Tangible: € 26.244
 Intangible: € 0
 TOTAL
 Tangible: € 76.494
 Intangible: € 128.353
Net present values and benefit-cost ratios
 Net present value
 Referred youths
 Taxpayer: € € 79.891
 Crime victim tangible: € 70.538
 Crime victim intangible € 122.397
 Cumulative*: € 284.739
 Siblings:
 Benefit cost ratio
 Referred youths
 Taxpayer: 14.41
 Crime victim tangible: 12.84
 Crime victim intangible 21.55
 Cumulative: 48.81
 *: Includes the incremental costs of MST over CAU
Sensitivity analysis
Max (plausible) values
Crime victim intangible benefits: € 387.085
Discount rates: € 239.009
Posttreatment arrest rates: € 478.277
Min (plausible) values
Crime victim intangible benefits : € 188.217
Discount rates: € 311.107
Posttreatment arrest rates: € 91.673
  1. Currency and price year: Schoenwald 1996.USD, 1996; French 2003. United States Dollar (USD), 1999; Mc Collister (2009). USD,2008; Olsson (2010) Swedish krona (SEK), 2007; Cary (2013). Pounds, 2008; Dopp (2014) USD, 2012; Borduin (2015) USD, 2013. When a price year was not stated it was estimated by taking the mean year of the study duration or when not available subtracting 1 from the year of publication of the study. For Schoenwald et al. (2006), 1996 was taken as prices year although the study was also published in 1996. This was because they already published their first study in 1996 (preliminary findings) and subsequently probably the current study was conducted in 1996
  2. MST multisystemic therapy, Joint combination of individual and family therapy, group skill-focused psycho-education group intervention, CAU care as usual, FSN family support network, MDFT multidimensional family treatment, MET/CBT12 motivational enhancement treatment/cognitive behavior therapy, 12 sessions, MET/CBT5 motivational enhancement treatment/cognitive behavior therapy, 5 sessions, ACRA adolescent community reinforcement approach, DC drug court with community services, DC + MST drug court with multisystemic therapy; DC + MST + CM drug court with MST and enhanced with a contingency management programs, FFT functional family therapy, FC family court with community services, MST-PSB MST for sexual behaviors; ICER incremental cost-effectiveness ratio