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The value of social investments: A health economic approach to evaluating parenting interventions
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.ORCID iD: 0000-0002-9866-1100
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Child mental health problems are current welfare challenges and may be costly to the individual, the family and society at large. The problems may persist and result in adverse outcomes later in life, which also carries a large financial burden. Parenting interventions are effective strategies to prevent or reduce mental health problems in children and are potentially cost-effective and even cost-saving. This thesis sets out to fill the knowledge gaps regarding the social investment case for parenting interventions in Sweden. Study I evaluated five indicated parenting interventions compared to a waitlist control. Long-term projections of health-related quality-of-life and cost-offsets related to the reduction of externalising behaviour problems in children were made using an economic decision simulation model. Study II assessed the financial impact of the five parenting interventions, considering the child´s lifetime earnings. Study III assessed whether it was worth the extra spending to provide cognitive behavioural therapy for children, in addition to a parenting program, for the treatment of oppositional defiant disorder in children. A net benefit regression framework was employed to assess the willingness-to-pay needed for the intervention to become cost-effective. Study IV was a trial-based evaluation of a selective intervention delivered to Somali-born parents, valuing the health and economic impact on parents and children simultaneously, compared to a waitlist control. The evaluation merged impacts on parents and children to describe potential scenarios for cost-effectiveness. To provide an overview of the current evidence, Study V systematically reviewed the literature on the cost-effectiveness of parenting interventions, focusing on child outcomes. Results showed that the five indicated parenting interventions were highly cost-effective, and may yield substantial economic returns. Delivery of a parenting intervention in addition to an intervention for children yielded clinically relevant improvements but came at a cost exceeding estimates for the societal cost of children with oppositional defiant disorder. The delivery of a selective intervention generated significantly improved health outcomes, but cost-effectiveness depended on the willingness-to-pay, especially considering multiple effects concurrently. The systematic literature review suggested that parenting interventions were likely to be a cost-effective use of resources, particularly for the prevention of externalising and internalising problems. The findings suggest that parenting interventions may be a cost-effective approach for the prevention and treatment of child mental health problems, especially for externalising problems.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. , p. 102
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1701
Keywords [en]
health economics, cost-effectiveness, cost-benefit, public health, child health, mental health, parenting
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-422819ISBN: 978-91-513-1071-8 (print)OAI: oai:DiVA.org:uu-422819DiVA, id: diva2:1502842
Public defence
2021-01-22, Universitetshuset, sal IX, Biskopsgatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2020-12-21 Created: 2020-11-22 Last updated: 2021-01-25
List of papers
1. Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children
Open this publication in new window or tab >>Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children
2019 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0225503Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.

METHODS: A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.

RESULTS: Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.

CONCLUSIONS: Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-404248 (URN)10.1371/journal.pone.0225503 (DOI)000533930800039 ()31790442 (PubMedID)
Funder
Swedish Research Council, 2014 -10128Swedish National Board of Health and Welfare
Available from: 2020-02-16 Created: 2020-02-16 Last updated: 2021-06-14Bibliographically approved
2. Economic Return on Investment of Parent Training Programmes for the Prevention of Child Externalising Behaviour Problems
Open this publication in new window or tab >>Economic Return on Investment of Parent Training Programmes for the Prevention of Child Externalising Behaviour Problems
2020 (English)In: Administration and Policy in Mental Health and Mental Health Services Research, ISSN 0894-587X, E-ISSN 1573-3289, Vol. 47, no 2, p. 300-315Article in journal (Refereed) Published
Abstract [en]

Economic models to inform decision-making are gaining popularity, especially for preventive interventions. However, there are few estimates of the long-term returns to parenting interventions used to prevent mental health problems in children. Using data from a randomised controlled trial evaluating five indicated parenting interventions for parents of children aged 5-12, we modeled the economic returns resulting from reduced costs in the health care and education sector, and increased long-term productivity in a Swedish setting. Analyses done on the original trial population, and on various sized local community populations indicated positive benefit-cost ratios. Even smaller local authorities would financially break-even, thus interventions were of good value-for-money. Benefit-cost analyses of such interventions may improve the basis for resource allocation within local decision-making.

Keywords
Benefit–cost analysis, Mental health, Parenting
National Category
Other Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-404249 (URN)10.1007/s10488-019-00984-5 (DOI)000491455800001 ()31630323 (PubMedID)
Funder
Swedish Research Council, 2014-10,128
Available from: 2020-02-16 Created: 2020-02-16 Last updated: 2021-03-24Bibliographically approved
3. Adding the Coping Power Programme to parent management training: the cost‑effectiveness of stacking interventions for children with disruptive behaviour disorders
Open this publication in new window or tab >>Adding the Coping Power Programme to parent management training: the cost‑effectiveness of stacking interventions for children with disruptive behaviour disorders
Show others...
2020 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 30, p. 1603-1614Article in journal (Refereed) Published
Abstract [en]

Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8–12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015

Place, publisher, year, edition, pages
Springer Nature, 2020
Keywords
Cost-effectiveness, Cognitive behavioural therapy, parent management training, child psykology
National Category
Pediatrics Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-422816 (URN)10.1007/s00787-020-01638-w (DOI)000568978600001 ()32924086 (PubMedID)
Funder
Stiftelsen Söderström - Königska sjukhemmet, SLS-312941
Available from: 2020-10-15 Created: 2020-10-15 Last updated: 2023-10-31Bibliographically approved
4. The cost-effectiveness of a culturally tailored parenting program: the value of multiple outcomes
Open this publication in new window or tab >>The cost-effectiveness of a culturally tailored parenting program: the value of multiple outcomes
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-425527 (URN)
Available from: 2020-11-17 Created: 2020-11-17 Last updated: 2020-11-22
5. Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations
Open this publication in new window or tab >>Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations
2024 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 33, no 2, p. 323-355Article, review/survey (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-425529 (URN)10.1007/s00787-022-01969-w (DOI)000770503100001 ()35304645 (PubMedID)
Funder
Uppsala University
Available from: 2020-11-17 Created: 2020-11-17 Last updated: 2024-05-23Bibliographically approved

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