Cost-Effectiveness of a School-Based Social and Emotional Learning Intervention: Evidence from a Cluster-Randomised Controlled Trial of the Promoting Alternative Thinking Strategies Curriculum

Abstract

Background School-based social and emotional learning interventions can improve wellbeing and educational attainment in childhood. However, there is no evidence on their effects on health-related quality of life (HRQoL) or on their cost effectiveness. Objective Our objective was to evaluate the cost effectiveness of the Promoting Alternative Thinking Strategies (PATHS) curriculum. Methods A prospective economic evaluation was conducted alongside a cluster-randomised controlled trial of the PATHS curriculum implemented in the Greater Manchester area of England. In total, 23 schools (n = 2676 children) were randomised to receive PATHS, and 22 schools (n = 2542 children) were randomised to continue with usual practice. A UK health service perspective and a 2-year time horizon were used. HRQoL data were collected prospectively from all children in the trial via the Child Health Utility Nine-Dimension questionnaire. Micro-costing was undertaken to estimate the intervention costs. Missing data were imputed using multiple imputation. Results The mean incremental cost of the PATHS curriculum compared with usual practice was £32.01 per child, and mean incremental quality-adjusted life-years (QALYs) were positive (0.0019; 95% confidence interval [CI] 0.0009-0.0029). Assuming a willingness-to-pay threshold of £20,000 per QALY, the expected incremental net benefit of introducing the PATHS curriculum was £5.56 per child (95% CI − 14.68 to 25.81), and the probability of cost effectiveness was 84%. However, this probability fell to 0% when intervention costs included teacher's salary costs. Conclusion The PATHS curriculum has the potential to be cost effective at standard UK willingness-to-pay thresholds. However, the sensitivity of the cost-effectiveness estimates to key assumptions means decision makers should seek further information before allocating scarce public resources. Trial registration number ISRCTN85087674.This cluster-randomised controlled trial suggested that the Promoting Alternative Thinking Strategies (PATHS) curriculum is associated with a small increase in both QALYs and costs.School-based social and emotional learning interventions such as PATHS have the potential to be cost effective at conventional willingness-to-pay thresholds used in the UK.The probability of cost effectiveness is sensitive to assumptions made regarding the costs included.

A multi-criteria support for the cost-effectiveness analysis of health interventions/ Uma contribuição multicritério para a análise de custo-efetividade de medicamentos

“…Different MCDA methods are used to aid the decision-making process in many branches of knowledge, each one with its particularity [30,31]. To perform an ICER, the difference of total cost and total effectiveness between two treatments must be computed to reach an incremental cost and an incremental effectiveness [32]. Thus, the use of an MCDA method that performs a pairwise comparison between treatments' performances difference, criterion per criterion, can be a way to complement CEA due to the similarity of these methodologies.…”

Mental health support and training to improve secondary school teachers’ well-being: the WISE cluster RCT

“…Therefore, a cost-consequence framework that tabulates costs against several outcomes for staff and students is appropriate, rather than a more reductive cost-effectiveness or cost-utility analysis that attempts to summarise efficiency in a single ratio. 77 It provides a more complete analysis for policy-makers than a 'cost per unit improvement in WEMWBS score', which has no easy interpretation. Previous research has demonstrated limited correlation and overlap between the WEMWBS well-being scores and health-related utility scores (such as the EuroQol-5 Dimensions, three-level version) used to estimate quality-adjusted life-years.…”

Economics of Mental Health: Providing a Platform for Efficient Mental Health Policy

“…Several articles focused on efforts to improve mental health care for vulnerable populations [15][16][17][18]. Cullinan et al examined socioeconomic disparities in unmet need for student mental health services in higher education in Ireland [15].…”

“…Turner et al undertook an economic evaluation of a school-based social and emotional learning Intervention in the United Kingdom [18]. The intervention, Promoting Alternative Thinking Strategies (PATHS), aim of to promote self-control, emotional understanding, positive selfesteem, relationships and interpersonal problem-solving skills among children in pre-school and primary education settings through the provision of a taught curriculum.…”

“…The intervention, Promoting Alternative Thinking Strategies (PATHS), aim of to promote self-control, emotional understanding, positive selfesteem, relationships and interpersonal problem-solving skills among children in pre-school and primary education settings through the provision of a taught curriculum. The authors found that the PATHS curriculum had the potential to be cost effective at standard willingness-to-pay thresholds but more work was required before allocating scarce public resources [18].…”