Background: Problematic sexual behavior in youth represents a significant public health problem in need of evidence-based treatments. Unfortunately, such treatments are not available in most communities.
Objective: This study used a mixed quantitative-qualitative approach to investigate the economics of the implementation of Problematic Sexual Behavior - Cognitive-Behavioral Therapy (PSB-CBT), an evidence-based treatment for problem sexual behaviors in youth.
Participants and setting: Youth (N = 413) participated in PSB-CBT at six program sites in youth service agencies across the United States.
Method: We used cost-effectiveness ratios (CERs) to compare the direct and indirect costs of PSB-CBT to self- and caregiver-reported youth clinical outcomes (i.e., problem sexual behavior as well as secondary behavioral health problems). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d = 1.0). The design and interpretation of those quantitative analyses were informed by qualitative themes about program costs and benefits that were derived from interviews with 59 therapists, administrators, and stakeholders.
Results: CERs (i.e., $ per SD) were $1,772 per youth for problem sexual behavior and ranged from $2,867 to $4,899 per youth for secondary outcomes. These quantitative results, considered alongside the qualitative perspectives of interviewees, suggested that the implementation of PSB-CBT was cost-effective. The results were robust to uncertainty in key parameters under most, but not all, conditions.
Conclusions: The results have important implications for decisions made by administrators, policymakers, and therapists regarding use of community-based approaches to address problematic sexual behavior of youth.
Keywords: Cost-effectiveness analysis; Evidence-based treatment; Implementation; Mixed methods; Problematic sexual behavior.
Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.