Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
Andreas Meyer-Lindenberg
Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Medical Faculty Mannheim/ University of Heidelberg, Mannheim, Germany
Michael Rapp
Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
Alkomiet Hasan
Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, Augsburg, Germany
Peter Falkai
Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
Ute Habel
Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
Andreas Heinz
Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
Paul Plener
Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany; and Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
Franziska Kaiser
Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
Stefanie Weigold
Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
Nassim Mehran
Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
Aline Übleis
Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
Frank Padberg
Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
Background Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions. Aims To evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms. Method This is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov. Results Health service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average €409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of €0 was €354.3 (€978.5 to −€269.9). Results were confirmed for different scenarios and varying WTP thresholds. Conclusions The Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU.
