Centre for Economics & Policy in HealthCanolfan Economeg a Pholisi Iechyd (CEPhI)

A Parenting Programme for Children at Risk of Developing Conduct Disorder: A Cost-effectiveness

AnalysisEdwards RT, Ó Céilleachair A, Bywater T , Hughes DA & Hutchings J What is already known?

The costs of Conduct Disorder in childhood and associated costs in later life are potentially very great to the family, the NHS, social care services and the legal-justice system. Scott S, Knapp M, Henderson J & Maughen B. Financial cost of social exclusion: follow up study of anti-social children into adulthood. Br Med J 2001; 323:19. Parenting is right at the top of the Governments policy agenda. NICE argues that investment in parenting programmes should be based on evidence of effectiveness and cost-effectiveness. There are a growing number of parenting programmes but there is limited rigorous evidence of their effectiveness and cost-effectiveness.

Our Study- The main clinical trial is reported elsewhere (Hutchings etal 2007).

Participants116 children aged 36-59 Months (87% of the clinical sample)at risk of developing conduct disorders as measured by theproblem and intensity scoresof the Eyberg Child BehaviourIndex (ECBI).

ObjectiveTo investigate the relative cost-effectiveness of the Incredible Years BASIC Parenting Programme compared with a six-month waiting-list control. SettingSure Start areas in North and mid Wales.

DesignAn incremental cost-effectiveness analysis alongside a randomised controlled trial of the effectiveness of a group-parenting programme delivered through Sure Start in the community.

Primary Outcome MeasureIncremental cost per unit of improvement on the intensity score of the ECBI scale.

Table 3: Total Costs IY Programme

-£1,000

-£500

£0

£500

£1,000

£1,500

£2,000

£2,500

£3,000

£3,500

-20 0 20 40 60

Incremental Effect (ECBI Intensity Score)

Incremental Cost

EffectsBehaviour of the children in the intervention group improved whilst the behaviour of the children in the control group worsened or stayed the same . After 6 months we observed a 17 point decrease on the Eyberg Child behaviour index in the intervention group as compared with the control group.

ResultsA bootstrapped incremental cost-effectiveness ratio (ICER) point estimate of £73 was calculated per one point improvement on the intensity score of the ECBI (95% confidence interval £42 to £140). It would cost £5486 to bring the child with the highest ECBI score to below the clinical cut-off point and £1344 to bring the average child in the intervention group within the non-clinical limits on the ECBI intensity score (below 127). For a ceiling ratio of £100 per point increase in ECBI score, there is a 83.9% chance of the intervention being cost-effective

Sensitivity Analysis Categorising the sample into relatively mild, moderate and severe groups based on Eyberg intensity scores at baseline it was observed that the intervention appeared more cost-effective in those with the highest risk of developing conduct disorder.

ConclusionThe Incredible Years Child-Parenting Programme improves child behaviour at a small additional cost and consequently is likely to be cost-effective as compared with the waiting list control. At more severe levels of risk of developing conduct disorder the extra cost may be very small. This parenting programme involves a modest additional cost and demonstrates strong clinical effect suggesting it would represent good value for money for public spending.

Figure 1: 1,000 replication bootstrap cost-effectiveness plane

Figure 2: Cost-effectiveness acceptability curve

Project is supported by the Health FoundationAnd is an accepted Publication BMJ 2007

Contact Detailsr.t.edwards@bangor.ac.uk CEPhI, IMSCaR, Dean Street Building, University of Wales, Bangor,LL57 1UT Gwynedd, Wales  

0

0.2

0.4

0.6

0.8

1

£0 £50 £100 £150 £200 £250Value of ceiling ratio

Probability cost

-effective

0

0.2

0.4

0.6

0.8

1

£0 £50 £100 £150 £200 £250Value of ceiling ratio

Probability cost

-effective

COST ITEM TOTAL COST

Total cost of establishing and running an IY Parenting Group over the 12 week programme

£15468.51

Cost per child based on 8 children per group £1933.56

Cost per child based on 12 children per group £1289.04

Total costs of running an IY Parenting group excluding non-recurrent costs

£12763.65

Cost per child based on 8 children per group £1595.46Cost per child base don 12 children per group £1063.64