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

Abstract

BackgroundBehavior 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.MethodsA 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.ResultsIntervention 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.ConclusionsParenting 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.

Modelling in economic evaluation of mental health prevention: current status and quality of studies

“…They also assumed that the intervention effect gradually decreased with a specified decay rate. A decay rate of 50% was commonly used in included studies [ 46 , 52 , 58 , 73 ]. Another common assumption to extrapolate the long term intervention effectiveness was that considering the interventions run over the time horizon [ 33 – 35 , 50 , 67 – 69 ].…”

“…In models with a shorter time horizon, only 22 studies (44.9%) justified the use of a shorter time horizon. In 27 Markov models, three studies (accounted for 11.0% of all Markov models) did not explicitly state the cycle length [ 47 , 50 , 52 ] and 11 studies (accounted for 40.7% of all Markov models) did not provide any justification for the chosen cycle length [ 31 , 34 , 44 – 46 , 48 , 57 , 58 , 60 , 61 , 73 ].…”

The long‐term cost of childhood conduct problems: Finnish Nationwide 1981 Birth Cohort Study

“…For example, parent‐based interventions effectively reduce childhood externalizing behaviour problems (Mingebach, Kamp‐Becker, Christiansen, & Weber, 2018). Long‐term economic evaluations have found that parent training as prevention and treatment of childhood conduct disorders are cost‐effective (Mihalopoulos, Sanders, Turner, Murphy‐Brennan, & Carter, 2007; Nystrand, Feldman, Enebrink, & Sampaio, 2019; O’Neill, McGilloway, Donnelly, Bywater, & Kelly, 2013; Sampaio et al., 2018).…”

Programas parentales eficaces para el tratamiento de la conducta disruptiva: El caso del programa Empoderando Padres, Empoderando Comunidades

“…Si se analiza más de cerca el formato de distribución de EPEC, sus cursos parentales se aplican a grupos de padres, con un formato interactivo y de aprendizaje colaborativo que incluye elementos clave como la observación, las representaciones de situaciones y los debates grupales. Según la evidencia empírica, no solo las intervenciones grupales son mejores en coste-beneficio (Nystrand et al, 2019), sino que también parecen disminuir los sentimientos de aislamiento de los padres (Tully et al, 2017). Cuando los padres desarrollan relaciones con familias que presentan problemas similares, parece reducirse el estigma de contar con un hijo problemático al tiempo que mejora la percepción que las familias tienen sobre el apoyo social (Tully et al, 2018).…”