Table 6.
Summary of the accrued evidence for the cost impact of ABAs
| Study | Cost-effective? | Cost-effectiveness detail | Resonated with population? | Staff buy-in reported? |
|---|---|---|---|---|
| Reporting only implementation and running costs (IRC) | ||||
| Gitlin, USA, 2012 [36] | Not applicable |
Resource-intensive home delivery; Resource cost compare favourable to brand name antidepressants |
Yes | Yes |
| Reporting implementation and running costs AND health and/or social care related costs (IRHSC) | ||||
| Mayer, USA, 2010 [32] | ABA dominant against comparator |
Reported non-significant health care cost saving and difference in hospitalisation; Sample participants had significantly lower comorbidity (major driver in hospitalisation) than non-participants |
Unreported | Unreported |
| Ellis-Hill, UK, 2019 [34] | Not applicable |
All possible primary outcome measures demonstrate change in favour of ABA intervention; Measures of emotional well-being would be a more relevant study outcome |
Yes | Unreported |
| Including an economic evaluation (EE) | ||||
| Kahn, USA, 2001 [31] | Cost effective against comparator |
Cost per HIV infection averted is far less than the lifetime medical costs of HIV disease; $18,000 or less per infection averted (excluding savings from HIV medical costs averted) |
Unreported | Unreported |
| Stevens, UK, 2002 [40] | Cost effectiveness implied (no explicit statement) |
ICER = £105 per life year gained (95% CI: £33–391); Modal value: £90 per life year gained; Mean cost per additional 1-year quitter £825 (95% CI: £300–3500) |
Unreported | Unreported |
| Krukowski, USA, 2013 [35] | ABA dominant against comparator |
Implementation cost per kilogram lost was $45; Comparable weight loss; LHE delivered service cost almost half as much professionally delivered service; May reached more high-risk individuals |
Unreported | Unreported |
| Pizzi, USA, 2014 [37] | Cost effective against threshold value [Threshold: US $50,000-$100,000/QALY] |
Cost-effective treatment for managing depressive symptoms in older African Americans that compares favourably with the cost-effectiveness of previously tested approaches Cost per QALY range of $30,500-$76,500 |
Yes | Yes |
| Eckermann, Australia, 2014 [33] | Cost effectiveness implied |
Successful health promotion program with high community network impact and return on investment in practice; Multiplier impact on total community activity up to two years was 5.07 ($226,737 against $44,758 invested) |
Unreported | Unreported |
| Wingate, UK, 2017 [41] | Cost effective against comparator |
1:1 and group peer support over 8–12 months are cost saving in this setting, largely derived by difference in self-reported utilisations. Long term benefits should be investigated; Overall cost savings of £113.13 per participant per annum |
Unreported | Unreported |
| Chung, USA, 2018 [38] | Comparator dominant against ABA | Conservatively, higher start-up costs in ABA (to engage staff) though reflected increase attendance. Comparator intervention has a time-limited lifetime, longer time horizon may alter result. No significant differences in 12-month service-use costs | Unreported | Yes |
| Visram, UK, 2020 [42] | Cost effective against threshold value [Threshold: GBP £20,000-£30,000/QALY] |
£3,900/QALY gained (comparing favourably with typical UK threshold); Societal value of at least £3.45 for every £1 spent on the service; Model not designed for holistic, multi-component services and therefore possible results represent over- or under- estimation |
Unreported | Unreported |
| Yeary, USA, 2020 [39] | Inconclusive. ABA likely dominant against comparator |
$138 per kg lost; In previous studies cost analyses were not conducted separately by race and ethnicity. “Given black typically lose less weight than whites in behavioural weight loss intervention, cost per pound lost may have been considerably high among blacks” |
Unreported | Unreported |