Economic value of community-based services for problematic sexual behaviors in youth: A mixed-method cost-effectiveness analysis

Background: Problematic sexual behavior in youth represents a significant public health problem in need of evidence-based treatments. Unfortunately, such treatments are not available in most communities. Objective: This study used a mixed quantitative-qualitative approach to investigate the economics of the implementation of Problematic Sexual Behavior – Cognitive-Behavioral Therapy (PSBCBT), an evidence-based treatment for problem sexual behaviors in youth. Participants and setting: Youth (N=413) participated in PSB-CBT at six program sites in youth service agencies across the United States. Method: We used cost-effectiveness ratios (CERs) to compare the direct and indirect costs of PSBCBT to self- and caregiver-reported youth clinical outcomes (i.e., problem sexual behavior as well as secondary behavioral health problems). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d=1.0). The design and interpretation of those quantitative analyses were informed by qualitative themes about program costs and benefits that were derived from interviews with 59 therapists, administrators, and stakeholders. Results: CERs (i.e., $ per SD) were $1,772 per youth for problem sexual behavior and ranged from $2,867 to $4,899 per youth for secondary outcomes. These quantitative results, considered alongside the qualitative perspectives of interviewees, suggested that the implementation of PSBCBT was cost-effective. The results were robust to uncertainty in key parameters under most, but not all, conditions. Conclusions: The results have important implications for decisions made by administrators, policymakers, and therapists regarding use of community-based approaches to address problematic sexual behavior of youth.