Abstract
BackgroundPeople in prison experience a range of physical and mental health problems. Evaluating the effectiveness and efficiency of prison-based interventions presents a number of methodological challenges. We present a case study of an economic evaluation of a prison-based intervention (“Engager”) to address common mental health problems.MethodsTwo hundred and eighty people were recruited from prisons in England and randomised to Engager plus usual care or usual care. Participants were followed up for 12 months following release from prison. The primary analysis is the cost per quality-adjusted life year (QALY) gained of Engager compared to usual care from a National Health Service (NHS) perspective with QALYs calculated using the CORE 6 Dimension. A cost-consequences analysis evaluated cross-sectoral costs and a range of outcomes.ResultsFrom an NHS perspective, Engager cost an additional £2737 per participant (95% of iterations between £1029 and £4718) with a mean QALY difference of − 0.014 (95% of iterations between − 0.045 and 0.017). For the cost-consequences, there was evidence of improved access to substance misuse services 12 months post-release (odds ratio 2.244, 95% confidence Interval 1.304–3.861).ConclusionEngager provides a rare example of a cost-utility analysis conducted in prisons and the community using patient-completed measures. Although the results from this trial show no evidence that Engager is cost-effective, the results of the cost-consequences analysis suggest that follow-up beyond 12 months post-release using routine data may provide additional insights into the effectiveness of the intervention and the importance of including a wide range of costs and outcomes in prison-based economic evaluations.Trial registration(ISRCTN11707331).
Highlights
As of July 2020, there were approximately 80,000 people in prison in England and Wales, of which 96% are men and 95% are over the age of 18 [1]
Participants were included in the study if they were serving a prison sentence of 2 years or less in a male prison in England, with between 4 and 20 weeks remaining of their sentence and were identified as having or likely to have common mental health problems, including anxiety, depression, phobias, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD)
The primary objective of the trial was to evaluate the effectiveness of the Engager intervention in improving psychological and social outcomes for men with common mental health problems in prison, with a primary outcome of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) measured at 6 months after release from prison
Summary
As of July 2020, there were approximately 80,000 people in prison in England and Wales, of which 96% are men and 95% are over the age of 18 [1]. People in prison experience significant physical and mental health problems compared to their peers in the community. Meeting the physical and mental health care needs of people in prison population presents the health care, social care, welfare, housing and criminal justice agencies with challenges, both in terms of the logistics of working together to coordinate care as well as the significant resources required to meet the needs of this population. People in prison experience a range of physical and mental health problems. We present a case study of an economic evaluation of a prison-based intervention (“Engager”) to address common mental health problems. The results from this trial show no evidence that Engager is cost-effective, the results of the cost-consequences analysis suggest that follow-up beyond 12 months post-release using routine data may provide additional insights into the effectiveness of the intervention and the importance of including a wide range of costs and outcomes in prison-based economic evaluations.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
