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Included studies

In total we identified six studies198,612–616_{assessing the cost-effectiveness of relevant psychosocial interventions}

for maltreated children: five studies198,613–616_{were carried out using data from a trial and one study}612_{used a}

decision-analytic model. Of the five trial-based studies,198,613–616_{data were from four RCTs}198,613–615_{and one}

cohort study.616_{All six studies}198,612–616_{were published in English and were carried out in the USA}198,615,616

(n=3), the UK613,614(n=2) and Australia612(n=1). The basic characteristics of the six included studies198,612–616

are presented inTable 8, and more detailed descriptions are presented inChapter 4.

Summary of study characteristics

Participants

Age In the RCT-based evaluations, one study615_{included preschool children in foster care aged between}

3 and 5 years, one study615_{included children who had been adopted between the ages of 3 and}

8 years,613_{and two studies}198,614_{included a broader age range: the first study}198_{involved maltreated}

children between 1 and 16 years and the second study614_{used a sexual abuse sample of children aged}

between 6 and 14 years. In the cohort study,616_{no age range was reported, just the mean of the groups,}

which was 8.9 years in one group and 5.4 years in the other. The decision model612_{focused on a}

hypothetical cohort of 10-year old children.

Gender Four198,613,615,616_{of the five trial-based studies included both girls and boys, with an average of}

49% being girls (range 43_–54%). The exception focused on an intervention that was specifically for girls TABLE 7 Excluded studies: effectiveness (continued)

Study ID Reason for exclusion Design Intervention category

Lorber 1984598 _{Abuse prevention only UCS Systemic interventions} MacMillan 2005599 _{Abuse prevention only RCT Systemic interventions} Mersky 2011600 _{Abuse prevention only QEx Systemic interventions} Overbeek 2014601 _{Not evaluating the intervention}

–assessing risk factors

as moderators of recovery across both interventions (i.e. two interventions combined as one)

RCT Systemic interventions

Pereira 2013602 _{No child outcomes UCS RBI}

Rivara 1985603 _{Not child focused UCS Psychotherapy}

Sagatun 1988604 _{No evaluation UCS Intensive service models}

Sullivan 1990605 _{No data presented and no specific information about} the intervention aside from general descriptions of the techniques used in the facility

CS Psychotherapy

Swart 2014606 _{Participants were not recruited/selected on the basis of} their maltreatment

RCT CBT

Swart 2014607 _{Participants were not recruited/selected on the basis of} their maltreatment

RCT CBT

Szykula 1985608 _{Focus on family preservation CS Intensive service models} Vitulano 1990609 _{Family preservation; the only results presented are}

about placement and removal from home

CS Intensive service models Waxman 2009610 _{Child advocate programme, not a therapeutic}

intervention

CS Intensive service models

TABLE 8 Characteristics of included economic studies

Intervention

category Design Study record Country Intervention Comparator

Type of abuse Method of economic evaluation Measure of

outcome Costs included

Time horizon

CBT Decision

model

Gospodarevskaya

2012612 Australia TF-CBT and_{TF-CBT plus} SSRI Non-directive counselling and no treatment Sexual abuse

Cost–utility QALYs Cost of

intervention only

1 year and 30 years RCT Sharac 2011613 _{UK Parenting}

programmes

Services as usual Not specified

Cost-effectiveness Strengths and difficulties and parent satisfaction Health, social care and education 6 months

Psychoeducation RCT McCrone 2005614 _{UK Individual} psychotherapy Group-based psychoeducational therapy Sexual abuse

Cost–consequences Various symptom and functioning Cost of intervention only 2 years Intensive service models

RCT Lynch 2014615 _{USA MTFC RFC Not}

specified Cost-effectiveness Placement permanency Health, social care and education 2 years

Cohort Wood 1988616 _{USA Families First} child abuse prevention service

Services as usual Abuse or neglect

Cost–consequences Family

functioning and out-of-home placements Cost of intervention and out-of-home placements 1 year

Co-ordinated care RCT Swenson 2000198 _{USA Charleston} Collaborative Project for maltreated children

Services as usual Abuse or neglect

Cost–consequences Caregiver and child psychosocial functioning

Programme costs, youth service and out-of-home placements

3 months

RFC, regular foster care; SSRI, selective serotonin reuptake inhibitor.

DESCRIPTION OF STUDIES NIHR Journals Library www.journalslibrary.nihr.ac.uk

Abuse type Two studies612,614_{evaluated interventions for sexual abuse, two studies}198,616_{described the}

maltreatment type as abuse and neglect, and the remaining two were unspecified,613,615_{focusing on}

adopted or foster care populations.

Interventions

The interventions evaluated in these economic evaluations were heterogeneous, including treatment- focused CBT compared with non-directive counselling and a no-treatment arm for sexual abuse, parenting programmes compared with services as usual for adoptive parents, individual psychotherapy compared with group-based psychoeducation therapy for sexual abuse, multidimensional treatment foster care (MTFC) compared with regular foster care (RFC) for preschool children with emotional and behavioural problems, a child abuse prevention service compared with services as usual, and a collaborative care intervention for maltreated children compared with services as usual.

Economic study type and quality

The method of economic evaluation was a cost-effectiveness analysis in two studies613,615_{(effects measured}

on disease-specific scales), a cost_–utility analysis in a third study612_{[effects measured using a generic}

quality-of-life scale capable of generating quality-adjusted life-years (QALYs)] and the remaining three studies198,614,616_{are most accurately described as cost}

–consequences analyses (costs and outcomes presented separately and not formally combined).

The performance of each study on the economic evaluation critical appraisal checklist76_{is summarised}

inTable 9. Sample sizes were small in all of the trial-based studies,198,613–616_{ranging from a total of}

37 participants (two groups of 19 and 18) to a maximum of 117 participants (two groups of 57 and 60). Perspectives were commonly narrow, with two studies612,614_{including only the cost of the interventions}

TABLE 9 Performance of economic studies on the Economic Evaluation Critical Appraisal Checklist

Critical appraisal checklist criteria Gospodarevskaya 2012612 Sharac 2011613 McCrone 2005280 Lynch 2014615 Wood 1988616 Swenson 2000198 1. Was a well-defined question

posed?

Yes Yes Yes Yes Yes Yes

2. Comprehensive description of competing alternatives?

Yes Yes Yes Yes Yes Yes

3. Was the effectiveness established?

Yes Yes Yes Yes Yes Yes

4. Were all costs and outcomes identified?

No Yes No Yes No Yes

5. Were costs and outcomes measured accurately?

Yes Yes Yes Yes Yes Yes

6. Were costs and outcomes valued credibly?

Yes Yes Yes Yes No Yes

7. Were costs and outcomes adjusted for differential timing?

Yes N/A No No N/A N/A

8. Was an incremental analysis performed?

Yes Yes No Yes No No

9. Was allowance made for uncertainty?

Yes No No No No No

10. Were all issues of concern to users included?

Yes No Yes No No No

under evaluation and two studies198,616_{additionally including the cost of out-of-home placements.}

The remaining two studies613,615_{took a broader perspective, covering health, social care and education.}

Incremental analyses were reported in three612,613,615_{of the six studies and uncertainty was explored in only}

one study.612_{Discounting of costs and effects was not applied in two}614,615_{of the three studies with a}

follow-up duration of>1 year. Quality varied greatly, with the decision model,612published in 2012,

meeting a relatively high number of the critical appraisal criteria and the cohort study,616_{published in}

1988, meeting relatively few.

Excluded economic studies

A total of 16 papers116,504,587,588,617–628_{were excluded from the review of economic evidence and these are}

reported inTable 10. Six papers619–621,623,626,628_{were excluded because they did not involve an intervention}

and four papers587,618,624,625_{because the intervention in question did not meet criteria for inclusion, focusing}

on prevention rather than treatment. Two records622,627_{did not have a specific focus on maltreatment,}

three records116,504,588_{did not meet criteria for a full economic evaluation and one record}617_{was a}

conference abstract.