Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children

English version

Autoři: Camilla Nystrand ^aff001; Inna Feldman ^aff001; Pia Enebrink ^aff002; Filipa Sampaio ^aff001
Působiště autorů: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden ^aff001; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ^aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225503

Souhrn

Background

Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.

Methods

A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5–12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.

Results

Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.

Conclusions

Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.

Klíčová slova:

Behavior – Cost-effectiveness analysis – Economics – Epidemiology – Health economics – Children – Sweden – Comets

Zdroje

1. European Parliament: Council of the European Union (2014) Regulation (EU) No 282/2014 of the European Parliament and of the Council of 11 March 2014 on the establishment of a third Programme for the Union’s action in the field of health (2014–2020) and repealing Decision No 1350/2007/EC Text with EEA relevance.

2. Holmes EA, Ghaderi A, Harmer CJ, et al (2018) The Lancet Psychiatry Commission on psychological treatments research in tomorrow’s science. The Lancet Psychiatry 5:237–286 doi: 10.1016/S2215-0366(17)30513-8 29482764

3. Finansdepartementet (2017) The Swedish Government Bill (Regeringens proposition) 2017/18:1.

4. Skokauskas N, Lavelle TA, Munir K, et al (2018) The cost of child and adolescent mental health services. The Lancet Psychiatry 5:299–300

5. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime Prevalence and Age-of-Onset Distributions of. Arch Gen Psychiatry 62:593–602 doi: 10.1001/archpsyc.62.6.593 15939837

6. Whiteford HA, Degenhardt L, Rehm J, et al (2013) Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. Lancet 382:1575–1586 doi: 10.1016/S0140-6736(13)61611-6 23993280

7. Offord DR, Lipman EL, Duku EK (2001) Epidemiology of problem behavior up to age 12. In: Child deliquents Dev. Interv. Serv. needs. Thousand Oaks, CA. Sage Publications, Inc., pp 95–116

8. Balázs J, Keresztény À (2014) Subthreshold attention deficit hyperactivity in children and adolescents: A systematic review. Eur Child Adolesc Psychiatry 23:393–408 doi: 10.1007/s00787-013-0514-7 24399038

9. Moffitt TE, Child D (1990) Juvenile delinquency and attention deficit disorder: boys’ developmental trajectories from age 3 to age 15. Child Dev 61:893–910 doi: 10.1111/j.1467-8624.1990.tb02830.x 2364762

10. Erskine HE, Norman RE, Ferrari AJ, Chan GCK, Copeland WE, Whiteford HA, Scott JG (2016) Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry 55:841–850 doi: 10.1016/j.jaac.2016.06.016 27663939

11. Bevilacqua L, Hale D, Barker ED, Viner R, Adolescence-limited AL (2017) Conduct problems trajectories and psychosocial outcomes: a systematic review and meta ‑ analysis. Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-017-1053-4

12. Scott S, Knapp M, Henderson J, Maughan B (2001) Financial cost of social exclusion: follow up study of antisocial children into adulthood. Br Med J 323:191–191

13. Fazel M (2015) Mental health interventions in schools 1: Mental health interventions in schools in high-income countries. Lancet Psychiatry 1:377–387

14. Lundahl B, Risser HJ, Lovejoy MC (2006) A meta-analysis of parent training: Moderators and follow-up effects. Clin Psychol Rev 26:86–104 doi: 10.1016/j.cpr.2005.07.004 16280191

15. Serketich WJ, Dumas JE (1996) The effectiveness of behavioral parent training to modify antisocial behavior in children: A meta-analysis. Behav Ther 27:171–186

16. Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M (2013) Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review). Evid Based Child Health 8:318–692 doi: 10.1002/ebch.1905 23877886

17. The National Public Health Institute of Sweden (2013) Current practice and work with parenting interventions in municipalities, counties, regional offices and the voluntary sector (Så arbetar kommuner, landsting, kommun- och regionförbund och ideella organisationer med föräldrastöd). Stockholm, Sweden

18. Stockholm County Council (2015) Guidelines for support in evaluation and treatment (Riktlinjer till stöd för bedömning och behandling). Stockholm, Sweden

19. Sayal K, Taylor JA, Valentine A, Guo B, Sampson CJ, Sellman E, James M, Hollis C, Daley D (2016) Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial. Child Care Health Dev 42:521–533 doi: 10.1111/cch.12349 27272608

20. O’Neill D, McGilloway S, Donnelly M, Bywater T, Kelly P (2013) A cost-effectiveness analysis of the Incredible Years parenting programme in reducing childhood health inequalities. Eur J Heal Econ 14:85–94

21. Edwards RT, Céilleachair A, Bywater T, Hughes DA, Hutchings J (2007) Parenting programme for parents of children at risk of developing conduct disorder: Cost effectiveness analysis. Br Med J 334:682–685

22. Ford T, Hayes R, Byford S, et al (2018) The effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management programme in primary school children: results of the STARS cluster randomised controlled trial. Psychol Med 1–15

23. Scott S, Sylva K, Doolan M, Price J, Jacobs B, Crook C, Landau S (2010) Randomised controlled trial of parent groups for child antisocial behaviour targeting multiple risk factors: The SPOKES project. J Child Psychol Psychiatry Allied Discip 51:48–57

24. Mihalopoulos C, Sanders MR, Turner KMT, Murphy-brennan M, Carter R (2007) Does the Triple P Positive Parenting Program provide value for money? Aust N Z J Psychiatry 41:239–246 doi: 10.1080/00048670601172723 17464705

25. Sampaio F, Barendregt JJ, Feldman I, Lee YY, Sawyer MG, Dadds MR, Mihalopoulos C (2017) Population cost-effectiveness of the Triple P parenting programme for the treatment of Conduct Disorder: an economic modelling study. J. Eur. Child Adolesc. Psychiatry

26. Stattin H, Enebrink P, Özdemir M, Giannotta F (2015) A national evaluation of parenting programs in Sweden: The short-term effects using an RCT effectiveness design. J Consult Clin Psychol 83:1069–1084 doi: 10.1037/a0039328 26009784

27. Sampaio F, Enebrink P, Mihalopoulos C, Feldman I (2016) Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems. J Ment Health Policy Econ 19:201–212 27991419

28. Institute for Health Metrics and Evaluation (IHME) (2017) GBD Results Tool. http://ghdx.healthdata.org/gbd-results-tool.

29. Dental and Pharmaceutical Benefits Agency (Läkemedelsförmånsnämnden) (2003) Dental and Pharmaceutical Benefits Agency’s adivice on economic evaluations. 1–4

30. Nystrand C (2018) Technical report: Markov Model Used to Model Parenting Interventions for the Prevention of Externalizing Behavior Problems in Children and Adolescents.

31. Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S (2011) Applied Methods of Cost-effectiveness Analysis in Health Care, 1st ed. Oxford University Press, Oxford, UK.

32. Svensson M, Nilsson FOL, Arnberg K (2015) Reimbursement Decisions for Pharmaceuticals in Sweden: The Impact of Disease Severity and Cost Effectiveness. Pharmacoeconomics 33:1229–1236 doi: 10.1007/s40273-015-0307-6 26093889

33. Cunningham CE, Bremner R, Boyle M (1995) Large group community-based parenting programs for families of preschoolers at risk for disruptive behaviour disorders: utilization, cost effectiveness, and outcome. J Child Psychol Psychiatry 36:1141–1159 doi: 10.1111/j.1469-7610.1995.tb01362.x 8847377

34. Moretti MM, Braber K, Obsuth I (2013) Connect: An Attachment-focused treatment group for parents and caregivers–A principle based manual. Simon Fraser University

35. Kling Å, Forster M (2010) A Randomized Controlled Effectiveness Trial of Parent Management Training With Varying Degrees of Therapist Support. Behav Ther 41:530–542 doi: 10.1016/j.beth.2010.02.004 21035616

36. Webster-Stratton C, Reid MJ, Hammond M, Reid MJ, Treating MH, Webster-stratton C, Reid MJ, Hammond M (2004) Treating Children With Early-Onset Conduct Problems: Intervention Outcomes for Parent, Child, and Teacher Training. J Clin Child Adolesc Psychol 33:105–124 doi: 10.1207/S15374424JCCP3301_11 15028546

37. Forster M (2009) Five times more love (Fem gånger mer kärlek). Natur&Kultur, Stockholm, Sweden

38. Patterson GR (1982) Coercive family process. Castalia Publishing Co., Eugene, Oregon, United States

39. Barkley RA (1997) Defiant children: A clinician’s manual for assessment and parent training. Guilford Press, New York, United States

40. Bandura A (1986) Social foundations of thought and Action: A social cognitive theory. Prentice Hall, Englewood Cliffs, NJ. United States

41. Piaget J, Inhelder B (1962) The psychology of the child. Basic Books., New York

42. Colvin A, Eyberg S, Adams C (1999) Restandardization of the Eyberg Child Behavior Inventory. Unpubl. Manuscr.

43. Swanson JM (1992) The SNAP-IV Teacher and Parent Rating Scale. https://www.crfht.ca/files/8913/7597/8069/SNAPIV_000.pdf. Accessed 23 Nov 2017

44. Bonin EM, Stevens M, Beecham J, Byford S, Parsonage M (2011) Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: A modelling study. BMC Public Health 11:803 doi: 10.1186/1471-2458-11-803 21999434

45. Norén Selinus E, Molero Y, Lichtenstein P, Anckarsäter H, Lundström S, Bottai M, Hellner Gumpert C (2016) Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls. Acta Psychiatr Scand 134:533–545 doi: 10.1111/acps.12655 27714770

46. Jacobson NS, Truax P (1991) Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Methodol issues Strateg Clin Res 59:631–648

47. Sweden Statistics (Statistiska Centralbyrån) (2018) Population by region, marital status, age and sex. Year 1968–2017 (Folkmängden efter region, civilstånd, ålder och kön. År 1968–2017). http://www.statistikdatabasen.scb.se/pxweb/en/ssd/START__BE__BE0101__BE0101A/BefolkningNy/?rxid=f254b1d1-f1f7-4407-871d-f9d4d8d5da71. Accessed 3 Apr 2018

48. Global Burden of Disease (GBD) 2016 Disease and Injury Incidence and Prevalence Collaborators* (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 acute and chronic diseases and injuries in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1211–1259 doi: 10.1016/S0140-6736(17)32154-2 28919117

49. Högström J, Olofsson V, Özdemir M, Enebrink P, Stattin H (2017) Two-Year Findings from a National Effectiveness Trial: Effectiveness of Behavioral and Non-Behavioral Parenting Programs. J Abnorm Child Psychol 45:527–542 doi: 10.1007/s10802-016-0178-0 27334706

50. Braun S, Zeidler J, Linder R, Engel S, Verheyen F, Greiner W (2013) Treatment costs of attention deficit hyperactivity disorder in Germany. Eur J Heal Econ 14:939–945

51. Hakkaart-van Roijen L, Zwirs BWC, Bouwmans C, Tan SS, Schulpen TWJ, Vlasveld L, Buitelaar JK (2007) Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD). Eur Child Adolesc Psychiatry 16:316–326 doi: 10.1007/s00787-007-0603-6 17483870

52. Holden SE, Jenkins-jones S, Poole CD, Morgan CL, Coghill D, Currie CJ (2013) The prevalence and incidence, resource use and financial costs of treating people with attention deficit / hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). Child Adolesc Psychiatry Ment Health 7:1–13 doi: 10.1186/1753-2000-7-1

53. Klora M, Zeidler J, Linder R, Verheyen F, von der Schulenburg JMG (2015) Costs and treatment patterns of incident ADHD patients—a comparative analysis before and after the initial diagnosis -. Health Econ Rev 5:1–9 doi: 10.1186/s13561-015-0041-y

54. Snell T, Knapp M, Healey A, Guglani S, Evans-Lacko S, Fernandez JL, Meltzer H, Ford T (2013) Economic impact of childhood psychiatric disorder on public sector services in Britain: Estimates from national survey data. J Child Psychol Psychiatry Allied Discip 54:977–985

55. Telford C, Green C, Logan S, Langley K, Thapar A, Ford T (2013) Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder. Soc Psychiatry Psychiatr Epidemiol 48:337–344 doi: 10.1007/s00127-012-0530-9 22699685

56. Thernlund G, Schacht A (2010) Atomoxetine’s Effect on Societal Costs in Sweden. J Atten Disord 13:618–628 doi: 10.1177/1087054709332163 19365087

57. EpigearXL. https://www.epigear.com/Products/EpigearXL/epigearxl.html. Accessed 8 Mar 2018

58. Erskine HE, Ferrari AJ, Nelson P, Polanczyk G V., Flaxman AD, Vos T, Whiteford HA, Scott JG(2013) Research Review: Epidemiological modelling of attention-deficit/hyperactivity disorder and conduct disorder for the Global Burden of Disease Study 2010. J Child Psychol Psychiatry 54:1263–1274 doi: 10.1111/jcpp.12144 24117530

59. Herman PM, Mahrer NE, Wolchik SA, Porter MM, Jones S, Sandler IN (2015) Cost-Benefit Analysis of a Preventive Intervention for Divorced Families: Reduction in Mental Health and Justice System Service Use Costs 15 Years Later. Prev Sci 16:586–596 doi: 10.1007/s11121-014-0527-6 25382415

60. Hultkrantz L, Karpaty P, Vimefall E (2017) Education-earnings linkage for assessing societal benefits of interventions for children and youth in Sweden. Psychosoc Interv 26:171–179

61. Ungar WJ (2010) Economic Evaluation in Child Health. Oxford University Press, New York, USA

62. Ozbek A, Gencer O, Mustan AT (2018) Which parents dropout from an evidence-based parenting programme (Triple-P) at CAMHS? Comparison of programme-completing and dropout parents. Clin Child Psychol Psychiatry 135910451879229

Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children

Souhrn

Background

Methods

Results

Conclusions

Klíčová slova:

Zdroje

PLOS One

INSIGHTS from European Respiratory Congress

Současné pohledy na riziko v parodontologii

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií

Střevní příprava před kolonoskopií