Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT

Hassiotis, Angela; Poppe, Michaela; Strydom, André; Vickerstaff, Victoria; Hall, Ian; Crabtree, Jason; Omar, Rumana; King, Michael; Hunter, Rachael; Bosco, Alessandro; Biswas, Amitava; Ratti, Victoria; Blickwedel, Jessica; Cooper, Vivien; Howie, William; Crawford, Mike

doi:10.3310/hta22150

Cited by 25 publications

(20 citation statements)

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“…There were other reasons for poor fidelity of the intervention that are stated in our report in Health Technology Assessment 3 . However, our study findings highlight a more pressing question about the current level of implementation of positive behaviour support in community practice.…”

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confidence: 55%

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Hassiotis¹

2018

Br J Psychiatry

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confidence: 55%

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Hassiotis¹

2018

Br J Psychiatry

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“…Further details can be found in the main trial paper. 12,13 At 36 months, complete cost and utility data were available for 78 (72%) participants in the intervention arm and for 102 (74%) in the control arm. The 12-month consort diagram is reported in supplementary Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Decisions about health resource allocation should be based on the relative benefits and costs of interventions although these cannot be the sole criteria used. In light of the study finding that staff training in PBS did not reduce challenging behaviour above TAU, 12,13 it is essential that services, trainers and policymakers reach consensus as to whether PBS ought to be delivered by specialists or whether other 'light touch' approaches may be acceptable. Despite the 85% probability of being cost-effective at £30 000 WTP per QALY gained, training in PBS is unlikely to tackle serious organisational barriers that practitioners need to overcome if PBS skills are to be properly implemented.…”

Section: Discussionmentioning

confidence: 99%

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Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial

et al. 2020

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Background Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs). Aims We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276). Method We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective. Results Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI −0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI −603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold. Conclusions There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.

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“…The positive behaviour support (PBS) trial is a multicentre RCT involving community intellectual disability services and service users with mild to severe intellectual disability and challenging behaviour. Positive behaviour support is a multicomponent intervention that is designed to foster prosocial actions and enhance the person's quality of life and his/her integration within the local community.…”

Section: Second Example: the Pbs Trialmentioning

confidence: 99%

A full Bayesian model to handle structural ones and missingness in economic evaluations from individual‐level data

Gabrio

Mason

Baio

2018

Statistics in Medicine

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Funding informationThe Foundation BLANCEFLOR Boncompagni Ludovisi, née Bildt ; Mapi Group Economic evaluations from individual-level data are an important component of the process of technology appraisal, with a view to informing resource allocation decisions. A critical problem in these analyses is that both effectiveness and cost data typically present some complexity (eg, nonnormality, spikes, and missingness) that should be addressed using appropriate methods. However, in routine analyses, standardised approaches are typically used, possibly leading to biassed inferences. We present a general Bayesian framework that can handle the complexity. We show the benefits of using our approach with a motivating example, the MenSS trial, for which there are spikes at one in the effectiveness and missingness in both outcomes. We contrast a set of increasingly complex models and perform sensitivity analysis to assess the robustness of the conclusions to a range of plausible missingness assumptions. We demonstrate the flexibility of our approach with a second example, the PBS trial, and extend the framework to accommodate the characteristics of the data in this study. This paper highlights the importance of adopting a comprehensive modelling approach to economic evaluations and the strategic advantages of building these complex models within a Bayesian framework.

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Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT

Abstract: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 22, No. 15. See the NIHR Journals Library website for further project information.

Cited by 25 publications

References 70 publications

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Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial

A full Bayesian model to handle structural ones and missingness in economic evaluations from individual‐level data

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