Economic evaluation of a bio-psycho-social intervention for comorbid disorders in a traumatized population in post-war Kosovo
Wei-Lun Chang, Carit Jacques Andersen, Besa Shatri Berisha, Olena Estrup, Shr-Jie Wang
1Danish Institute Against Torture (DIGNITY) Copenhagen, Denmark
Objective: Post-hoc economic evaluation of a bio-psycho-social intervention in post-war Kosovo from a societal perspective.
Design: Cost-effectiveness analysis, cost-utility analysis, and partial cost-benefit analysis using data from a randomized controlled trial.
Patients: Thirty-four torture/war victims with comorbid conditions enrolled in 2012–2013.
Methods: Participants were randomly assigned to an “intervention” and a “waiting-list” group. Changes in mental, emotional and physical health and functional impairment were assessed before and after treatment, along with increase in labour income as a proxy for productivity gain. The cost of an extra unit of effectiveness and an additional quality-adjusted life year were calculated.
Results: The total cost per participant was €1,322 including, or €1,019 excluding, research costs. Wide variations in costs of changes in mental, emotional and physical effectiveness were demonstrated. Multidisciplinary intervention resulted in functional improvement at a cost of €10,508 per quality-adjusted life year gained. With a mean monthly income increase to €133 (18%) after intervention, the intervention cost per participant would be equal to the total increase in monthly income after 4–5 years, assuming the increased level is maintained.
Conclusion: Socio-economic benefit associated with quality-adjusted life year gain is shown, although the cost of an additional quality-adjusted life year is above the World Health Organization cost-effectiveness threshold.
Victims of torture or war are often traumatized with severe mental and physical damages which affect their mental and physical state, functionality, and ability to work. In this study, we evaluated the socio-economic effect of a bio-psycho-social intervention in 34 torture and war victims from post-war Kosovo. After 3-month treatment, we found that it was not cost-effective in terms of a gain of quality adjusted life years over a short time-span, but found an average monthly income increase by 18% among the participants. After 4-5 years, the accumulation of increase in their monthly income will equal to the extra cost invested in intervention per participant. We conclude on this basis that there is a socio-economic benefit associated with multidisciplinary intervention for torture and war victims, from a societal perspective, which not only outbalanced the intervention cost, but also contributed to labour productivity gain – multidisciplinary interventions benefit both the traumatized individual and the whole society in the post-conflict setting.