APPLICATION OF A MULTI-CRITERIA DECISION ANALYSIS FRAMEWORK FOR THE OPTIMISATION OF A COMPLEX PARENTING INTERVENTION IN SOUTHEAST EUROPE: A COST-CONSEQUENCES ANALYSIS OF THE FLOURISH FACTORIAL TRIAL
Author(s)
Dennis Wienand, PhD1, Michael Radloff, MSc2, Antonio Piolanti, PhD2, Janina Müller, PhD2, Viorel Babii, MSc3, Nevena Calovska, MD, PhD4, Heather Foran, PhD2, Miona Gajic, MSc5, Nina Heinrichs, PhD6, Galina Lesco, MD, PhD3, Graham Moore, PhD7, Marija Raleva, MD, PhD8, Swetha Sampathkumar, PhD7, Yulia Shenderovich, PhD7, Bojan Shimbov, PhD9, Judit Simon, BA, BSc, MSc, DPhil, MD10.
1Medical University of Vienna, Vienna, Austria, 2University of Klagenfurt, Klagenfurt, Austria, 3Asociatia Obsteasca Sanatate Pentru Tineri (Health for Youth Association), Chisinau, Moldova, Republic of, 4Sinigdunum University, AST Centre for Education, Belgrade, Serbia, 5University of Belgrade, AST Centre for Education, Belgrade, Serbia, 6Bielefeld University, Bielefeld, Germany, 7Cardiff University, Cardiff, United Kingdom, 8Institute for Marriage, Family, and Systemic Practice ALTERNATIVA; St Cyril and Methodius University, Skopje, North Macedonia, The Republic of, 9University Jaume I Castellon, Castellón de la Plana, Spain, 10University of Oxford and Medical University of Vienna, Vienna, Austria.
1Medical University of Vienna, Vienna, Austria, 2University of Klagenfurt, Klagenfurt, Austria, 3Asociatia Obsteasca Sanatate Pentru Tineri (Health for Youth Association), Chisinau, Moldova, Republic of, 4Sinigdunum University, AST Centre for Education, Belgrade, Serbia, 5University of Belgrade, AST Centre for Education, Belgrade, Serbia, 6Bielefeld University, Bielefeld, Germany, 7Cardiff University, Cardiff, United Kingdom, 8Institute for Marriage, Family, and Systemic Practice ALTERNATIVA; St Cyril and Methodius University, Skopje, North Macedonia, The Republic of, 9University Jaume I Castellon, Castellón de la Plana, Spain, 10University of Oxford and Medical University of Vienna, Vienna, Austria.
OBJECTIVES: Adolescent mental health is a global health issue requiring effective and scalable interventions. The FLOURISH (Family-Focused Adolescent & Lifelong Health Promotion) project adapts, implements, and evaluates an intervention for adolescent mental health and well-being in North Macedonia and Moldova. Present study aimed to evaluate costs and consequences of intervention packages by applying multi-criteria decision analysis (MCDA).
METHODS: In a factorial, cluster-randomised controlled trial, adolescents (10-14 years) and caregivers received an intervention, Parenting for Lifelong Health (PLH) Teens. Participants were additionally randomised towards three add-on components (HAT workshop, peer support resources, engagement boosters). Outcome data were collected at baseline and eight weeks after baseline. Cost data reflected intervention costs such as training, material, and staff costs. We conducted a cost-consequences analysis (CCA) alongside MCDA, with scenarios determined by an optimisation schedule, and criteria, measures and weights by stakeholder inputs. Intervention conditions were assessed based on outcome changes from baseline to post-assessment using multi-level regression. Interventions were compared based on costs per combined benefit score (CBS) versus a contextual threshold.
RESULTS: We assessed eight conditions against seven criteria reflecting diverse adolescent, caregiver, and joint outcome measures. Delivery of the core intervention only (PLH only) was least cost-intensive at €162 per family, yielded a CBS of 42 and thereby constituted a threshold of €3.86 per CBS. PLH+HAT was most effective with a CBS of 75 at €248 per family, and dominated all two or three add-on conditions. Other single add-on conditions demonstrated positive effects, but were less cost-effective than PLH+HAT.
CONCLUSIONS: This study informed optimised component selection in FLOURISH, and piloted MCDA for complex intervention assessments. PLH only and PLH+HAT contended for implementation with comparable incremental cost per CBS. While PLH+HAT yielded the highest overall CBS, its beneficial performance was more heterogeneous. Qualitative implementation data further indicated optimisation needs of HAT beyond scope of FLOURISH.
METHODS: In a factorial, cluster-randomised controlled trial, adolescents (10-14 years) and caregivers received an intervention, Parenting for Lifelong Health (PLH) Teens. Participants were additionally randomised towards three add-on components (HAT workshop, peer support resources, engagement boosters). Outcome data were collected at baseline and eight weeks after baseline. Cost data reflected intervention costs such as training, material, and staff costs. We conducted a cost-consequences analysis (CCA) alongside MCDA, with scenarios determined by an optimisation schedule, and criteria, measures and weights by stakeholder inputs. Intervention conditions were assessed based on outcome changes from baseline to post-assessment using multi-level regression. Interventions were compared based on costs per combined benefit score (CBS) versus a contextual threshold.
RESULTS: We assessed eight conditions against seven criteria reflecting diverse adolescent, caregiver, and joint outcome measures. Delivery of the core intervention only (PLH only) was least cost-intensive at €162 per family, yielded a CBS of 42 and thereby constituted a threshold of €3.86 per CBS. PLH+HAT was most effective with a CBS of 75 at €248 per family, and dominated all two or three add-on conditions. Other single add-on conditions demonstrated positive effects, but were less cost-effective than PLH+HAT.
CONCLUSIONS: This study informed optimised component selection in FLOURISH, and piloted MCDA for complex intervention assessments. PLH only and PLH+HAT contended for implementation with comparable incremental cost per CBS. While PLH+HAT yielded the highest overall CBS, its beneficial performance was more heterogeneous. Qualitative implementation data further indicated optimisation needs of HAT beyond scope of FLOURISH.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE190
Topic
Economic Evaluation, Epidemiology & Public Health
Disease
Mental Health (including addiction)