Hester van Eeren

General introduction | 1 11 | Economic evaluation Given this ‘current state of play’, municipalities have to choose between available interventions. However, though there is substantial budget available, the budgets were cut in recent years and the budgets are limited, since municipalities have to spend their money on various domains (Transitie Autoriteit Jeugd, 2017). As a result, municipalities only have a limited budget to help ‘their’ youth and their families by reimbursing these interventions. It would thus be useful to have information on both the effectiveness and the costs of the interventions offered. Costs and effects are jointly evaluated in a cost-effectiveness analysis, which is increasingly being used to inform decisions regarding the reimbursement of health care interventions. In these analyses, the costs are preferably considered from a societal perspective, in which all relevant costs are included, irrespective of the payer perspective (Drummond, Sculpher, Torrance, O’Brien, & Stoddart, 2005; Zorginstituut Nederland, 2015). A cost-effectiveness analysis can reveal various outcomes. For example, if the new intervention is more effective and less costly than the alternative or current treatment, the new intervention is preferred over the alternative. Moreover, when the new intervention is more effective, and the new and alternative interventions cost the same, or when both interventions are equally effective while the new intervention is less costly, the new intervention is also preferred. However, the reimbursement decision becomes more complicated if the new intervention is more effective and more costly. It should then be decided whether the additional effects of the more effective intervention are worth the additional costs (Drummond et al., 2005). In the situation where the new intervention is more effective and more costly, the additional costs of the new intervention can be divided by the additional effects, which represents the Incremental Cost-Effectiveness Ratio (ICER). This ICER value can be compared to the amount of money the decision-maker, or society, would be willing to pay for an additional unit of effect. If the ICER then is lower than the willingness-to-pay (WTP) value, the new interventions is cost-effective. However, if the ICER is higher than the WTP value, investing in the new intervention is not possible or rather questionable and one would stick with the alternative or current intervention (Briggs, Claxton, & Sculpher, 2006). Although nowadays economic evaluations are often used when evaluating health care and especially when evaluating new medicines (Rutten, 2010; Zorginstituut Nederland, 2015), cost-effectiveness analyses in youth care are not yet broadly applied. In the Netherlands, the guidelines on cost-effectiveness analyses only shortly describe their application in mental and forensic health care (Zorginstituut Nederland, 2015). Nevertheless, the number of cost-effectiveness analyses in youth care, but also in mental health care and in crime prevention, has increased (e.g., Knapp, McDaid, Evers, Salvador-Carulla, Halsteinli, & MHEEN Group, 2008; Soeteman & Busschbach, 2008).