UK mental health engagement programme too costly for prisoners near release?

Abstract

A UK-based mental health engagement programme, Engager, may be too costly per prisoner, but is associated with improved access to substance misuse services 12 months after release, according to a study published in the European Journal of Health Economics. Two hundred and eighty adults in English prisons were randomised to the Engager intervention (patient-centred engagement processes that addresses wider support issues) plus usual care or usual care alone. Follow-up was 12 months following release from prison. The primary focus was cost per quality-adjusted life-year (QALY) gained of Engager versus usual care from an NHS perspective. Direct medical and non-medical costs were included, and employment costs were costed as productivity gains using the human capital approach. A cost-consequences analysis evaluated cross-sectoral costs and engagement with a range of outcomes. The Engager intervention resulted in additional costs of £2737 per patient and a mean QALY difference of –0.014. For the cost-consequence analysis, there appeared to be improved access to substance misuse services at 12 months after release (odds ratio 2.244; 95% CI 1.304, 3.861). The researchers conclude that, 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 .