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

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.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 pound 002; SAU: 4336) pound, 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.