Hester van Eeren

| Chapter 6 6 | 144 which complicates the comparison of intervention A and intervention B over year X and Y. Thus, the context of the selected dataset and of the evaluation study should be considered and discussed when interpreting its findings. Second, not only research into the effectiveness and cost-effectiveness of youth care should be brought together, but also the criteria used to evaluate this research. The criteria used to rank the level of effectiveness of interventions could for instance be combined with the criteria used to decide on the reimbursement of interventions in youth care. The level of effectiveness of youth interventions can be found in the Database Effective Interventions (Netherlands Youth Institute, 2016). As described in the introduction of this thesis, the DEI is based on the so-called ‘effectladder’ in which an intervention is marked according to four ranked categories (Veerman & van Yperen, 2008). The criteria to decide upon reimbursement, on the other hand, are formulated from a health economic perspective that is originally based on the ‘Trechter van Dunning’ (Busschbach & Delwel, 2010; Roscam Abbin, 1991). The decision to reimburse health care interventions is based on four criteria, of which proven effectiveness is the second criterion, after having evaluated the need for intervening, the necessity, in the first place (Busschbach & Delwel, 2010; Roscam Abbin, 1991; Zwaap, Knies, van der Meijden, Staal, & van der Heijden, 2015). The third criterion considers the cost-effectiveness, or efficiency, of the intervention. Combining the criteria could be accomplished by incorporating the youth care perspective, for example given in the criteria of the ‘effectladder’, in the second criterion of the ‘Trechter van Dunning’, which is also described in a report on how to decide upon the level of evidence in research and practice concerning health care (Zwaap et al., 2015). Another way to combine the effectiveness and the cost-effectiveness criteria could be to add the criteria for reimbursement of interventions to the level of evidence included in the DEI. This could be a first step in bringing evidence and decisions about reimbursements together in youth care, or at least to make the criteria to decide upon the level of evidence more explicit. A future step might even be to introduce and apply more detailed and explicit decision criteria, which could be brought together in a multi-criteria decision analysis (Baltussen & Niessen, 2006; Thokala & Duenas, 2012). A multi-criteria decision analysis is an approach to explicitly incorporate and weigh several criteria in a systematic and transparent way (Baltussen & Niessen, 2006; Thokala & Duenas, 2012). These criteria are scored and weighted to a sum score per treatment alternative. Policy makers can use this score as a tool to inform their reimbursement decision. As this approach is more widely applied in health technology assessment nowadays, it could be a tool to indeed bringing criteria to decide upon the reimbursement of youth care together and make them explicit and transparent. Third, cost-effectiveness research in youth care needs guidelines that can improve the implementation of health economic evaluations in this field, because this type of research is not yet widely applied. For example, youth care could incorporate the already existing guidelines and best practices in health economics (Zorginstituut Nederland, 2015), by which it would also follow international health technology assessment standards because these are included in these guidelines. In addition, these guidelines could be adjusted on advises and best practices that specifically fit this type of research