Economic Evaluation of the SOS Training to Reduce Victimization in Dual Diagnosis Patients

• Published in: Journal of dual diagnosis Vol. 17; no. 4; pp. 333 - 343
• Main Authors: de Waal, Marleen M., Blankers, Matthijs, Lommerse, Nick M., Kikkert, Martijn J., Dekker, Jack J. M., Goudriaan, Anna E.
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 02-10-2021; Taylor & Francis Ltd
• Subjects: co-occurring disorders; Cost analysis; Cost-Benefit Analysis; cost-effectiveness; Crime Victims; Diagnosis, Dual (Psychiatry); Dual diagnosis; economic evaluation; Humans; Netherlands; Police; psychiatric comorbidity; substance use disorders; Training; treatment; Victimization; Willingness to pay; Netherlands; Dual diagnosis; cost-effectiveness; treatment; substance use disorders; victimization; economic evaluation; co-occurring disorders; psychiatric comorbidity
• ISSN: 1550-4263; 1550-4271
• DOI: 10.1080/15504263.2021.1965409

Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyze the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU).
We performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up.
There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [−€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [−0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs.
At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs.