Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: a modelling study

Abstract

BackgroundConduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known about their potential long-term cost-effectiveness. We therefore estimate the costs of and longer-term savings from evidence-based parenting programmes for the prevention of persistent conduct disorder.MethodsA decision-analytic Markov model compares two scenarios: 1) a 5-year old with clinical conduct disorder receives an evidence-based parenting programme; 2) the same 5-year old does not receive the programme. Cost-savings analysis is performed by comparing the probability that conduct disorder persists over time in each scenario, adopting both a public sector and a societal perspective. If the intervention is successful in reducing persistent conduct disorder, cost savings may arise from reduced use of health services, education support, social care, voluntary agencies and from crimes averted.ResultsResults strongly suggest that parenting programmes reduce the chance that conduct disorder persists into adulthood and are cost-saving to the public sector within 5-8 years under base case conditions. Total savings to society over 25 years are estimated at £16,435 per family, which compares with an intervention cost in the range of £952-£2,078 (2008/09 prices).ConclusionsEffective implementation of evidence-based parenting programmes is likely to yield cost savings to the public sector and society. More research is needed to address evidence gaps regarding the current level of provision, longer-term effectiveness and questions of implementation, engagement and equity.

Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective

“…The guidance confirmed the previous health technology assessment analyses and recommended the use of high-quality evidence-based parenting programmes to prevent the development of antisocial behaviour and conduct disorders. Similar to the economic modelling study by members of our own group, 20 and by Lee et al, 21 the NICE guidance 13 shows good financial returns from investment in evidence-based programmes.…”

“…174 Evidence from model-based analyses suggests that parenting programmes are likely to provide substantial savings (e.g. Aos et al 175 and Bonin et al 20 ). However, it is important to note that these analyses are relying on the limited empirical evidence currently available.…”

“…In this study, we adapted our previous model estimating the longer-term savings from parenting programmes intended to prevent persistence of behaviour problems. 20 We drew on additional literature and created a 'low-cost' and a 'high-cost' scenario. In addition, we varied the assumptions around the natural course of conduct disorder.…”

“…20 The original model included parameters for intervention take-up and dropout. No data for take-up are available in our data set, and, as results for the present study were obtained on an intention-to-treat basis, dropout is already accounted for in the overall effectiveness figure.…”

Support for Adoption Placements: The First Six Months

“…High quality support from GPs and successful referrals to specialist services will support the adoptive family and help improve placement stability, and may also prevent any early childhood problems escalating into more serious conditions, with potentially far higher support costs, as the child ages. For example, one recent analysis shows that early intervention for childhood conduct disorder may generate a return to the public sector of up to £45 per pound invested from reduced use of health and social care services, and crimes averted (Bonin et al, 2011).…”