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Randomized Controlled Trial
. 2025 Aug 29;47(3):478-486.
doi: 10.1093/pubmed/fdaf038.

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

Manuela Deidda  1 , Helen Minnis  2 , Karen Crawford  2 , Robin Young  3 , Gary Kainth  2 , Julia Donaldson  4 , Matt Forde  4 , Alex McConnachie  3 , Christopher Gillberg  2   5 , Marion Henderson  6   7 , Philip Wilson  8   9 , Kathleen A Boyd  1 , Emma McIntosh  1
Affiliations
Randomized Controlled Trial

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

Manuela Deidda et al. J Public Health (Oxf). .

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.

Keywords: children; cost effectiveness; mental health.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Total cost per arm, by cost type.
See this image and copyright information in PMC

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References

    1. Fang X, Brown DS, Florence CS et al. The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse Negl 2012;36:156–65. 10.1016/j.chiabu.2011.10.006. - DOI - PMC - PubMed
    1. Corso PS, Edwards VJ, Fang X et al. Health-related quality of life among adults who experienced maltreatment during childhood. Am J Public Health 2008;98:1094–100. 10.2105/AJPH.2007.119826. - DOI - PMC - PubMed
    1. Knapp M, King D, Healey A et al. Economic outcomes in adulthood and their associations with antisocial conduct, attention deficit and anxiety problems in childhood (in submission). J Ment Health Policy Econ 2013;14:137–47. - PubMed
    1. Conti G, Pizzo E, Morris S et al. The economic costs of child maltreatment in UK. Health Econ 2021;30:3087–105. 10.1002/hec.4409. - DOI - PubMed
    1. Mitchell MB. “No one acknowledged my loss and hurt”: non-death loss, grief, and trauma in foster care. Child Adolesc Soc Work 2018;35:1–9. 10.1007/s10560-017-0502-8. - DOI

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