1.21 Cost-Effectiveness and Utilization of Multisystemic Therapy for Conduct Disorder: A Systematic Review

The purpose of this study is to determine the utilization and cost-effectiveness of multisystemic therapy (MST) in treating patients with conduct disorders, because the cost of mental health services is often scrutinized by policymakers. The aim is to focus on more effective and less costly individualized treatment in family-focused community-based services. A comprehensive search of published studies on “Multisystemic therapy” OR “Multisystemic family therapy” was conducted on PubMed, CINAHL Complete, APA PsycINFO, Cochrane Library, and Embase databases until January 31, 2023, and it yielded 564 articles. After removing duplicate results and screening articles per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines revealed 13 randomized trials investigating cost-effectiveness of MST for conduct disorder. According to Dopp et al, 2017 MST cost-benefit analysis of New Mexico data, the implementation of MST reduces $4643 per youth in behavioral health claims and $15,019 per youth via reducing juvenile crime. Another 2015 study for MST on juvenile sexual offenders showed lower rates of posttreatment arrest and saved $48.81 per every dollar spent on MST. A similar study in 2014 found the lasting cost-benefit of MST posttreatment of juvenile offenders by reducing criminality and saving $5.04 per dollar spent on MST. A UK study estimated MST cost-savings of £1,222 per adolescent with criminal activity. However, a Swedish study found a positive impact of MST by reducing the other out-of-home placement but caused a net loss of 44,500 SEK ($4535.45) per youth in 2 years. Study results support the 1996 trial by Schoenwald et al, which indicated that utilizing MST services reduces the overall lifetime treatment cost by decreasing the number of days in an inpatient stay, residential care, and incarceration. Additional benefits included a reduction (26%) in rearrests and drug use. The study has shown the cost-effectiveness of MST, which also considerably reduces the number of inpatient and residential treatment days and reduces the number of incarceration in adolescents using the substance. To determine the cost-benefits of MST, which accounts for recent changes in cost and billing rates, we recommend future randomized well-designed trials.