Self-help intervention for Syrian refugees more cost effective than enhanced care alone

The implementation of self-help psychological interventions for improving the health of Syrian refugees and asylum seekers in Turkey was more cost effective than enhanced care alone, according to a study published in JAMA Network Open.

“Although governments of most host countries, often in collaboration with national and international nongovernmental organizations, provide at least emergency care for refugees or asylum seekers, to date the availability of evidence-based mental health and psychosocial support programs for this group is insufficient,” A-La Park, MSc, of the department of psychiatry and psychotherapy II at the University of Ulm in Germany, and colleagues wrote.

Park and fellow researchers sought to determine the cost effectiveness of the Self-Help Plus (SH+) program, a psychological self-help intervention developed by the WHO, combined with enhanced usual care and compared with enhanced usual care alone for Syrian refugees in Turkey.

The evaluation was performed as part of an assessor-blind randomized clinical trial conducted between Oct. 1, 2018, and Nov. 30, 2019, with a 6-month follow-up. A total of 627 adults (mean age, 31.3 years; 62.9% female) with psychological distress but no diagnosed psychiatric disorder were randomly assigned on a 1:1 basis to the SH+ intervention — an audio-based, 2-hour, five-session, group self-help stress management course, or to the enhanced usual care group.

The latter included access to free health care services provided by primary and secondary institutions, as well as details on nongovernmental organizations and freely available mental health services, social services and community networks. Primary outcome was incremental cost per quality-adjusted life-year gained from the perspective of the Turkish health care system. Data were analyzed from Sept. 30, 2020, to July 30, 2021.

Results showed an incremental cost-utility ratio estimate of T£6,068 (USD, $1,147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T£14,831 ($2,802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone.

“The results of this economic evaluation suggest that providing the SH+ intervention ... may increase the quality of life for this population,” Park and colleagues wrote.