Cost-effectiveness of multidimensional family therapy compared to cognitive behavioral therapy for adolescents with a cannabis use disorder: Data from a randomized controlled trial

Objective: To evaluate the cost-effectiveness of Multidimensional Family Therapy (MDFT) for adolescents with a cannabis use disorder, compared to Cognitive Behavioural Therapy (CBT).
Methods: A parallel-group randomized controlled trial was performed. 109 adolescents with a DSM-IV cannabis use disorder (CBT n = 54; MDFT n = 55) were included. Assessments were conducted at baseline, and 3, 6, 9 and 12 months post-baseline, and included measures on cannabis and other substance use, delinquency, health care utilization, and general health related quality of life.
Results: Excluding those with missing cost-data, 96 participants (MDFT n = 49; CBT n = 47) were included. From a health care perspective, the average annual direct medical costs in the CBT group were € 2015, compared to € 5446 in the MDFT group. The average qualityadjusted life years (QALY’s) gained were 0.06 QALY higher for the MDFT group, which led to an incremental cost-effectiveness ratio (ICER) of 54,308 Euro/QALY or € 43,405 per recovered patient. Taking the costs of delinquency into account, the costs increased to € 21,330 for the CBT group and to € 21,915 for the MDFT group, which lead to an ICER of 9266 Euro/QALY or a cost per recovered patient of € 7491.
Conclusions: This is the first comprehensive CEA of MDFT compared to CBT and it demonstrated that when costs of delinquency were included, the ICERS were modest. The results underline the importance of adopting a broader perspective regarding cost effectiveness analyses in mental health care.