Economic evaluations in marital and family therapy outcome research: Methodologies and applications

David Preston Mackinnon, Purdue University

Abstract

The purpose of the present study was to provide (1) a thorough, systematic description of economic evaluation methodology in the context of marital and family therapy outcome research, and (2) a step-by-step application of the methodology on a previously-reported, well-known, and influential marital and family therapy outcome study which had not previously been subjected to economic evaluation. The literature of marital and family therapy, other mental health fields, general health care and health promotion fields, and various non-health care fields such as business and education were reviewed for economic evaluation methodology and application examples. A systematic economic evaluation methodology was presented which paid particular attention to family systems issues. Economic evaluation techniques such as net present value analysis and sensitivity analysis were described in detail. The methodology was specifically applied to a well-regarded, alcoholism treatment study which included marital therapy in its Community Reinforcement treatment protocol. Employers, managed care companies, and hospital providers were chosen as the target markets on whom the applications were made. Data were gathered from interviews with representatives of each of the target markets. The results were discounted to the present for comparison purposes. The present study found that adding the Community Reinforcement Program to traditional alcoholism treatment increased time on the job (i.e., reduced absenteeism) more cost effectively than traditional alcoholism treatment alone. It was also discovered that the combined Community Reinforcement Program plus traditional treatment program generated a significantly better benefit to cost ratio than the traditional treatment alone. Lastly, the present study found that the Community Reinforcement Program alone did not return monetary (i.e., reimbursements from managed care companies) or non-monetary (i.e., days not institutionalized) benefits in the same magnitude as the traditional treatment program alone. Adding the Community Reinforcement Program to traditional alcoholism treatment therefore made economic sense to employers and managed care companies but not hospital providers. Sensitivity analyses conducted on all findings determined that variations in key assumptions did not affect the conclusions. Future directions for the development of economic evaluations in marital and family therapy outcome research were discussed.

Degree

Ph.D.

Advisors

Sprenkle, Purdue University.

Subject Area

Psychological tests|Families & family life|Personal relationships|Sociology|Economics

COinS