Mental Health Intervention for Children with Epilepsy (MICE): cost-effectiveness analysis of psychological therapy in addition to usual care compared with assessment-enhanced usual care alone for children and young people with epilepsy and common mental health disorders.
Ganguli P., Bennett SD., Chowdhury K., Cross JH., Chorpita B., Coughtrey AE., Dalrymple E., Fonagy P., Ford T., Heyman I., Moss-Morris R., Stephenson T., d'Oelsnitz A., Shah M., Blackstone J., Quartly H., MICE Consortium ., Shafran R., Byford S.
BACKGROUND: Mental health issues are prevalent among children and young people (CYP) with chronic conditions like epilepsy, yet few access evidence-based psychological therapies. Evidence from the Mental Health Intervention for Children with Epilepsy (MICE) trial supports the effectiveness of a personalised modular psychological intervention, but cost-effectiveness is unknown. AIMS: To assess the cost-effectiveness of the MICE intervention compared with assessment-enhanced usual care at 12-months follow-up, taking a health and social care perspective. METHOD: We conducted a within-trial economic evaluation. Outcomes were the Strengths and Difficulties Questionnaire (SDQ; primary) and quality-adjusted life years (QALYs; secondary) for CYP, caregivers, and CYP and caregivers combined. Sensitivity analyses examined missing data and intervention-costing assumptions. RESULTS: Cost-effectiveness results for the SDQ indicated that MICE had a higher probability of being cost-effective compared with control at a willingness to pay ≥£368 per unit improvement. For QALYs, MICE had a lower probability of being cost-effective for CYP compared with control (35 to 42%) across the £20 000-£30 000 per QALY threshold range. However, at the upper threshold this finding was reversed in sensitivity analyses with missing data imputed (45 to 58%) and with MICE costed at 75%, assuming the intervention partly substituted standard services (46 to 55%). Furthermore, MICE had a higher probability of being cost-effective for caregiver QALYs (52 to 63%) and combined CYP and caregiver QALYs (62 to 75%). CONCLUSIONS: MICE appears to be cost-effective compared with assessment-enhanced usual care when considering QALYs for CYP and caregivers combined, though uncertainty exists across willingness-to-pay thresholds.