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Population cost-effectiveness of the Triple P parenting programme for the treatment of Conduct Disorder: an economic modelling study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. (CHAP)ORCID iD: 0000-0002-5540-9853
Epigear International, Sunrise Beach, Australia; School of Public Health, University of Queensland, Brisbane, Australia.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. (CHAP)ORCID iD: 0000-0003-3329-6066
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2018 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 27, no 7, p. 933-944Article in journal (Refereed) Published
Abstract [en]

Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P—Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a ‘no intervention’ scenario, using a health sector perspective. The model targeted a cohort of 5–9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471–1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146–39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.

Place, publisher, year, edition, pages
2018. Vol. 27, no 7, p. 933-944
Keywords [en]
Population model, Conduct disorder, Children and adolescents, Cost-effectiveness, Parenting programme
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Economics
Identifiers
URN: urn:nbn:se:uu:diva-281348DOI: 10.1007/s00787-017-1100-1ISI: 000435956400012PubMedID: 29288334OAI: oai:DiVA.org:uu-281348DiVA, id: diva2:913854
Funder
Swedish Research Council Formas, 259-2012-68Available from: 2016-03-22 Created: 2016-03-22 Last updated: 2019-07-02Bibliographically approved
In thesis
1. Prevention and Treatment of Externalizing Behaviour Problems in Children through Parenting Interventions: An Application of Health Economic Methods
Open this publication in new window or tab >>Prevention and Treatment of Externalizing Behaviour Problems in Children through Parenting Interventions: An Application of Health Economic Methods
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The early onset of externalizing behaviour problems (EBP) is associated with negative outcomes later in life, such as poor mental health, substance use, crime, and unemployment. Some children also develop conduct disorder (CD), entailing a high disease and economic burden for both individuals and society.

Most studies on the effectiveness and cost-effectiveness of parenting interventions targeting EBP among children have evaluated selective or indicated preventive interventions, or treatment strategies. Evidence on the effectiveness of universally delivered parenting programmes is controversial, partly due to methodological difficulties.

The overall aim of this thesis was to 1) address the methodological challenges of evaluating universal parenting programmes, and to 2) employ different health economic methods to evaluate parenting interventions for EBP and CD in children.

Study I indicated that offering low intensity levels of Triple P universally, with limited intervention attendance, does not result in improved outcomes, and may not be a worthwhile use of public resources. Study II showed that using the distribution of an outcome variable makes it possible to estimate the impact of public health interventions at the population level. Study III supports offering bibliotherapy to initially target CP in children, whereas Comet could be offered to achieve greater effects based on decision-makers’ willingness to make larger investments. Cope could be offered when targeting symptom improvement, rather than clinical caseness. The economic decision model in Study IV demonstrated that Triple P for the treatment of CD appears to represent good value for money, when delivered in a Group format, but less likely, when delivered in an Individual format.

To reduce the burden of mental health problems in childhood, cost-effective and evidence-based interventions should be provided on a continuum from prevention through early intervention to treatment. We believe our results can assist decision-makers in resource allocation to this field.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. p. 72
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1203
Keywords
parenting interventions, externalizing behaviour problems, conduct problems, conduct disorder, health economics, cost-effectiveness, prevention, treatment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Child and Youth Psychiatry; Health Care Research; Economics
Identifiers
urn:nbn:se:uu:diva-281349 (URN)978-91-554-9530-5 (ISBN)
Public defence
2016-05-17, Eva Netzeliussalen (BH/10:K102), Kraemers Allé 1, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2016-04-25 Created: 2016-03-22 Last updated: 2016-04-29

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