Project title:

Economic evaluation of the EQUIP programme

Type of research:

Economic evaluation alongside a clinical trial

Background & Scientific Rationale:

It has been argued that that criminal offending is associated with a developmental delay in moral reasoning, distorted cognitions, and social skills (Gibbs et al, 2010). To address this, Funding has been awarded for a clinical trial to evaluate the EQUIP Programme (Equipping Youth to Help One Another Treatment) (Langdon, NIHR Fellowship). It is expected that this intervention will help to reduce problematic behaviours and reduce the need for hospital admission. Due to the nature of the award, it was not possible to include an economic evaluation as part of the fellowship application. MRC Guidance (2008) recommends the inclusion of an economic evaluation as it will make evaluation results more useful for decision makers, as they aim to ensure that scarce NHS resources are used efficiently and provide the greatest possible benefit to patients.The project is a randomised clinical trial of the EQUIP treatment programme for people with intellectual disabilities who are detained within a hospital providing in-patient treatment for offenders with intellectual and other development disabilities (five hospitals in the East of England are taking part). Patients will be randomised into one of two arms: 1) treatment as usual or 2) the EQUIP programme. This fully powered study requires 49 participants in each arm. Across the 5 hospitals there are 219 beds, thus over the 18 month recruitment period we consider that it is feasible to recruit the proposed numbers. The trial was due to start late 2013 but was delayed and started in 2016.

Research aims:

To estimate the cost-effectiveness of the EQUIP programme, compared to treatment as usual.

Proposed methods:

Costs will be estimated from the viewpoint of the NHS and personal social services (PSS). Resources associated with the EQUIP treatment programme will thereby be monitored along with other NHS and PSS costs e.g. other health professional visits and hospital admissions. Appropriate unit costs will subsequently be assigned to each item of resource use for a standard price year. The main measure of effectiveness to be used in the economic analysis will be the EQ-5D (Brooks, 1996). The EQ-5D is a generic measure of quality of life and will enable a cost-utility analysis to be conducted based on the estimated QALY (Quality Adjusted Life Year) gain for each treatment option. In order to obtain the above resource use and quality of life information interviews will be conducted, and case-notes searched, pre- and post-intervention (based on previous PPI work 40 minutes per participant has been estimated as sufficient to undertake this work).

Expected Output of Research / Impact and added value:

This study is being added onto a trial which has already been funded (enhancing the value of the trial). As such, it can also provide information for a relatively low cost. The information obtained regarding the costs and benefits of the two treatment options will be used to make an assessment as to whether the EQUIP programme offers value for money, or whether resources would provide better value if spent elsewhere.

For further information on this project, contact Professor Garry Barton at



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