Title: Systematic review and cost effectiveness modelling of the clinical and cost-effectiveness of art therapy among people with non-psychotic mental disorders.
Funder: Department of Health (England)

Abstract: Project design : Systematic review evidence synthesis and meta-analysis of quantitative and qualitative studies examining the clinical and/or cost-effectiveness of art therapy for non-psychotic mental health disorders. Aims and objectives1) To determine the relative clinical efficacy of art therapy compared with currently used packages of care for people with non-psychotic mental disorders. A full systematic review of the literature will be undertaken to provide evidence on efficacy.2) To provide a detailed user perspective on the acceptability and relative benefits and potential harms of art therapy a second systematic review will be undertaken on the available qualitative research literature.3) To undertake a full synthesis of available evidence and generate probability distributions for uncertain parameters for use in an economic model.4) To undertake a full economic analysis. This will include a systematic review of published economic evaluations in the area and identification of other evidence needed to populate an economic model. Cost effectiveness will be assessed in terms of the incremental cost per quality adjusted life year (QALY) gained from a probabilistic analyses. Uncertainty in the most cost-effective treatment will be illustrated using cost-effectiveness acceptability curves.5) To determine the value of collecting further data on all or some of the input parameters an expected value of information analysis will be performed.Design and MethodsSearch strategyWe will:1. Use major health-related and health economic electronic bibliographic databases; 2. Consult via the internet with key health service organisations and guideline producing bodies; 3. Consult national and international experts in research and clinical practice (both referring to and practising art therapy);4. Use patient and public involvement in a project advisory/steering group comprising the project team; and referring psychiatrists;5. Search the UK Clinical Research Network Portfolio Database; archive of National Research Register Current Controlled Trials (and its links: Clinical Trials.gov; HSRProj; and Index to Theses) to identify ongoing/recently completed research; 6. Use existing systematic reviews to identify relevant studies; 7. Identify Grey literature; 8. Examine reference lists of included studies for further relevant references and if appropriate use the citation facility in Web of Science to search for specific papers/authors; 9. Not restrict searches by language or date. In the process of study selection we will: 1. Use a three-line strategy to identify studies using wide ranging multi-disciplinary databases with sifting to examine title and abstract then article full-text; 2. Use complementary strategies of citation tracking citation pearl growing to identify relevant related articles; 3. Target Dissertation Abstracts and Index to Theses for qualitative research reports; 4. Identify “sibling studies” e.g. process evaluations; and identify mixed methods studies blending quantitative and qualitative research within a common context to maximise external validity and; 5. Track studies through citation linkage from included Randomised Controlled Trials (RCTs) and follow-up of principal investigator web sites. Review strategy We will include reports of systematic reviews RCTs and economic evaluations of art therapy interventions in any non-psychotic mental disorder in all settings using controls or specific comparators. The clinical outcomes of interest are: 1. Changes to mental health and; 2. Patient acceptability of treatment. We will also assess the quality of the quantitative and qualitative studies. Qualitative meta-synthesis will provide added value to the quantitative analysis by indicating patient issues around the acceptability of art therapy as a treatment for non-psychotic mental disorders. Data will be extracted using a standardised data extraction tool and double checked by a second reviewer. Quantitative evidence synthesisWe will use network meta-analysis to allow a comprehensive synthesis and comparison of the relative effects of each intervention to a reference intervention (to be defined). The output from the network meta-analysis will include:• Point estimates and 95% credible intervals for the relative effect of each intervention to a reference intervention• A ranking of the interventions and an assessment of the probability that each intervention is the best• A joint probability distribution for the effect of each intervention to represent uncertainty about uncertain inputs in the economic modelThe model for the data will be a random effects model that acknowledges that each study is estimating a related but not identical intervention effect. Qualitative evidence synthesis We will include qualitative research which: 1. Examines patient acceptability from reports by people who have received art therapy interventions;2. Examines how patient acceptability may affect clinical effectiveness using data within trial reports or process evaluations and; 3. Reports the acceptability of interventions to health care practitioners with data from separately conceived research or within trial reports. For cost-effectiveness modelling:Where appropriate clinical effectiveness estimates will be obtained by meta-analysis of available evidence and network meta-analyses with the cost per QALY as the final outcome. Expected output: The project is registered on the PROSPERO international register of systematic reviews. We plan to disseminate findings in high profile journals; at national and international conferences; and to guideline development bodies. We aim to feed the results into curricula for professional education. If necessary recommendations for the direction of future trials in art therapy will be made.Approval by ethics committeesAs the project is a synthesis of existing evidence and does not require primary data collection no ethical approval is required.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH