Economic Return on Investment of Parent Training Programmes for the Prevention of Child Externalising Behaviour Problems

Nystrand, Camilla; Hultkrantz, Lars; Vimefall, Elin; Feldman, Inna

doi:10.1007/s10488-019-00984-5

Cited by 12 publications

(7 citation statements)

References 62 publications

(75 reference statements)

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“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 26 studies performed both univariate sensitivity analysis and probabilistic sensitivity analysis. Although it is recommended that the ranges used for sensitivity analysis be stated clearly and justified, many models did not specify the value ranges and their reasons [36,39,40,49,54,55,57,58,60,61,63,71,72]. Besides, only 12 studies clearly described and justified the choice of distribution for each parameter [25,30,33,35,37,38,42,47,50,53,57,67].…”

Section: Datamentioning

confidence: 99%

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

Thu

Huong

Anh

et al. 2022

BMC Health Serv Res

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Background The present study aimed to identify and critically appraise the quality of model-based economic evaluation studies in mental health prevention. Methods A systematic search was performed on MEDLINE, EMBASE, EconLit, PsycINFO, and Web of Science. Two reviewers independently screened for eligible records using predefined criteria and extracted data using a pre-piloted data extraction form. The 61-item Philips Checklist was used to critically appraise the studies. Systematic review registration number: CRD42020184519. Results Forty-nine studies were eligible to be included. Thirty studies (61.2%) were published in 2015–2021. Forty-seven studies were conducted for higher-income countries. There were mainly cost-utility analyses (n = 31) with the dominant primary outcome of quality-adjusted life year. The most common model was Markov (n = 26). Most of the studies were conducted from a societal or health care perspective (n = 37). Only ten models used a 50-year time horizon (n = 2) or lifetime horizon (n = 8). A wide range of mental health prevention strategies was evaluated with the dominance of selective/indicate strategy and focusing on common mental health problems (e.g., depression, suicide). The percentage of the Philip checkilst’s criteria fulfilled by included studies was 69.3% on average and ranged from 43.3 to 90%. Among three domains of the Philip checklist, criteria on the model structure were fulfilled the most (72.1% on average, ranging from 50.0% to 91.7%), followed by the data domain (69.5% on average, ranging from 28.9% to 94.0%) and the consistency domain (54.6% on average, ranging from 20.0% to 100%). The practice of identification of ‘relevant’ evidence to inform model structure and inputs was inadequately performed. The model validation practice was rarely reported. Conclusions There is an increasing number of model-based economic evaluations of mental health prevention available to decision-makers, but evidence has been limited to the higher-income countries and the short-term horizon. Despite a high level of heterogeneity in study scope and model structure among included studies, almost all mental health prevention interventions were either cost-saving or cost-effective. Future models should make efforts to conduct in the low-resource context setting, expand the time horizon, improve the evidence identification to inform model structure and inputs, and promote the practice of model validation.

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Section: Resultsmentioning

confidence: 99%

Section: Datamentioning

confidence: 99%

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

Thu

Huong

Anh

et al. 2022

BMC Health Serv Res

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“…Externalizing behavior problems Among the high-quality studies (n = 14), there was evidence that preventive interventions targeting children with symptoms and parenting interventions delivered as treatment, including group and individual face-to-face programs [26, 27,31,35,43,46] were cost-effective and even cost-saving for targeting externalizing behaviors. CBA analyses of some of these programs targeting prevention showed cost-benefit ratios between US$6.48 and US$17.18 per dollar invested over the long-term [27], with savings to society over a 25 year horizon of $28,994 per family [31], or $13,364 over 20 years per child [46]. Another study estimated net benefits on the population level of $31.3 million if a minimum reduction of 25% of cases of conduct problems were achieved [35].…”

Section: Mental Healthmentioning

confidence: 99%

“…One study found incremental cost-effectiveness ratios (ICER) of $778 per DALY averted for group therapy and $15,744 per DALY averted for individual therapy (probability of cost-effectiveness between 99.2% and 99.5%) [43]; and another study reported ICERs between $6,527 and $9,923 per QALY for a parent only intervention compared to a parent and teacher variant [47]. Well-established and disseminated parenting interventions, such as the Incredible Years [26,27], and the Triple P-Positive Parenting Program [35,43] were likely to be cost-effective at local WTP thresholds. Among the moderate quality studies (n = 7), group-based interventions had similar outcomes at lower costs compared to individual formats [41], and interventions targeting different combinations of parent, teacher, and child formats yielded better outcomes at higher costs than care as usual [33,40,42,70].…”

Section: Mental Healthmentioning

confidence: 99%

Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations

Sampaio

Nystrand

Feldman

et al. 2022

Eur Child Adolesc Psychiatry

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A comprehensive review of the economic evidence on parenting interventions targeting different aspects of child health is lacking to support decision-making. The aim of this review is to provide an up to date synthesis of the available health economic evidence for parenting interventions aiming to improve child health. A systematic review was conducted with articles identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and outcomes were included. We assessed the quality of the studies using the Drummond checklist. We identified 44 studies of varying quality that met inclusion criteria; 22 targeting externalizing behaviors, five targeting internalizing problems, and five targeting other mental health problems including autism and alcohol abuse. The remaining studies targeted child abuse (n = 5), obesity (n = 3), and general health (n = 4). Studies varied considerably and many suffered from methodological limitations, such as limited costing perspectives, challenges with outcome measurement and short-time horizons. Parenting interventions showed good value for money in particular for preventing child externalizing and internalizing behaviors. For the prevention of child abuse, some programs had the potential of being cost-saving over the longer-term. Interventions were not cost-effective for the treatment of autism and obesity. Future research should include a broader spectrum of societal costs and quality-of-life impacts on both children and their caregivers.

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“…Many regional health authorities around the world offer near-universal access to group-based parenting programs, with some including options for more tailored services to higher-needs families (e.g., Child & Family Services of Northwestern Michigan, n.d.;Healthy Child Manitoba, 2016;Hutchings, 2012;Pickering & Sanders, 2015;Ulfsdotter et al, 2015). Estimated benefits-to-cost ratios of group based parenting programs range from 5.96 to 15.8, with savings in education, healthcare, and income-earning potential far outweighing the costs of implementing group-based parenting programs (Nystrand et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Group-Based Parenting Programs for Preschoolers: Exploring Moderation by Participants, Programs, and Time

Penner-Goeke¹,

Kaminski²,

Sulymka³

et al. 2020

Preprint

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Group-based parenting programs have been implemented for over 50 years as a cost-effective way to promote child mental health and reduce behavior problems. However, some evidence suggests that their effects are limited and inconsistent. To inform next steps in program development, more systematic examinations about the overall efficacy of programs for both parenting and child outcomes in early childhood is needed as well as the program and family level factors that predict for whom programs work more or less well. We conducted a systematic review and meta-analysis of randomized-controlled-trials in preschool aged children over the past 20 years (2000 to 2020). Sixty-five articles evaluating group-based parenting programs for 3 to 5-year-old children were included (N = 7658). Meta-analytic results indicated that programs had small overall effects on improving parenting quality and child behaviours. Significant heterogeneity was present with parent-report of child behaviour outcomes linked to greater effect sizes compared to teacher or observer reports. Moderator analyses showed that higher parental education and children’s clinically significant disruptive behaviour problems were linked to greater improvements in parenting quality. There were also significant effects of publication year on child behaviour outcomes, suggesting that program effects have been improving over time. Other moderator analyses were not possible due to limited reporting of theorized factors (e.g., parent mental health). Overall, group-based programs are linked to improvements in parenting and child outcomes during the preschool age. Continued innovation in program development is recommended to increase efficacy and tailor service type and intensity to specific family needs.

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Economic Return on Investment of Parent Training Programmes for the Prevention of Child Externalising Behaviour Problems

Cited by 12 publications

References 62 publications

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

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

Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations

A Meta-Analysis of Group-Based Parenting Programs for Preschoolers: Exploring Moderation by Participants, Programs, and Time

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