Economic evaluation of a complex intervention to improve the mental health of maltreated children in foster care (BeST? Services trial)

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Deidda, Manuela and Minnis, Helen and Crawford, Karen and Young, Robin and Kainth, Gary and Donaldson, Julia and Forde, Matt and McConnachie, Alex and Gillberg, Christopher and Henderson, Marion and Wilson, Philip and Boyd, Kathleen A. and McIntosh, Emma (2025) Economic evaluation of a complex intervention to improve the mental health of maltreated children in foster care (BeST? Services trial). Journal of Public Health. fdaf038. ISSN 1741-3842 (https://doi.org/10.1093/pubmed/fdaf038)

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Abstract

Background: Children in foster care who have experienced abuse and neglect are at risk of poor long-term health and societal outcomes. Evidence on the costs, benefits and cost-effectiveness of early interventions aimed at improving the mental health of abused and neglected children is limited. Methods: This study reports the within-trial economic evaluation alongside BEST?, a randomized controlled trial comparing the New Orleans Intervention Model (NIM) with services as usual (SAU), targeting children aged 0–60 months entering UK foster care. In line with guidance for conducting economic evaluations of complex and social care interventions, a cost-utility analysis (CUA) estimated incremental cost of NIM per quality-adjusted life year (QALY); a cost-effectiveness analysis estimated incremental cost per unit improvement in child mental health; and a cost-consequence analysis combined costs with broad-ranging outcomes. Results: NIM is significantly more costly than SAU (NIM: £10 002; SAU: £4336), with wide cost variations according to context. There are no significant differences between NIM and SAU in QALYs or child mental health. Conclusions: Within the current UK care systems, NIM is not a cost-effective alternative to SAU. However, these results need to be interpreted with caution and within the prevailing service provision context.

ORCID iDs

Deidda, Manuela, Minnis, Helen, Crawford, Karen, Young, Robin, Kainth, Gary, Donaldson, Julia, Forde, Matt, McConnachie, Alex, Gillberg, Christopher, Henderson, Marion ORCID logoORCID: https://orcid.org/0000-0001-7582-9516, Wilson, Philip, Boyd, Kathleen A. and McIntosh, Emma;
CORE (COnnecting REpositories)