Economic evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: a cost-utility and cost-consequences analysis

Rachael Maree Hunter (), Rob Anderson, Tim Kirkpatrick, Charlotte Lennox, Fiona Warren, Rod S. Taylor, Jenny Shaw, Mark Haddad, Alex Stirzaker, Mike Maguire and Richard Byng
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Rachael Maree Hunter: University College London (UCL)
Rob Anderson: University of Exeter
Tim Kirkpatrick: University of Manchester
Charlotte Lennox: University of Manchester
Fiona Warren: University of Exeter
Rod S. Taylor: University of Exeter
Jenny Shaw: University of Manchester
Mark Haddad: City, University of London
Alex Stirzaker: NHS England, South West Mental Health Clinical Network
Mike Maguire: University of South Wales
Richard Byng: University of Plymouth

The European Journal of Health Economics, 2022, vol. 23, issue 2, No 4, 193-210

Abstract: Abstract Background People in prison experience a range of physical and mental health problems. Evaluating the effectiveness and efficiency of prison-based interventions presents a number of methodological challenges. We present a case study of an economic evaluation of a prison-based intervention (“Engager”) to address common mental health problems. Methods Two hundred and eighty people were recruited from prisons in England and randomised to Engager plus usual care or usual care. Participants were followed up for 12 months following release from prison. The primary analysis is the cost per quality-adjusted life year (QALY) gained of Engager compared to usual care from a National Health Service (NHS) perspective with QALYs calculated using the CORE 6 Dimension. A cost-consequences analysis evaluated cross-sectoral costs and a range of outcomes. Results From an NHS perspective, Engager cost an additional £2737 per participant (95% of iterations between £1029 and £4718) with a mean QALY difference of − 0.014 (95% of iterations between − 0.045 and 0.017). For the cost-consequences, there was evidence of improved access to substance misuse services 12 months post-release (odds ratio 2.244, 95% confidence Interval 1.304–3.861). Conclusion Engager provides a rare example of a cost-utility analysis conducted in prisons and the community using patient-completed measures. Although the results from this trial show no evidence that Engager is cost-effective, the results of the cost-consequences analysis suggest that follow-up beyond 12 months post-release using routine data may provide additional insights into the effectiveness of the intervention and the importance of including a wide range of costs and outcomes in prison-based economic evaluations. Trial registration (ISRCTN11707331).

Keywords: Cost-utility; Cost-consequences; Prison; Common mental health problems; Mentalisation therapy (search for similar items in EconPapers)
JEL-codes: I10 (search for similar items in EconPapers)
Date: 2022
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DOI: 10.1007/s10198-021-01360-7

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