Hajizadeh Negin, Stevens Elizabeth R, Applegate Melanie, Huang Keng-Yen, Kamboukos Dimitra, Braithwaite R Scott, Brotman Laurie M
Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA.
Department of Population Health, New York University School of Medicine, 227 E. 30th St, New York, NY, 10016, USA.
BMC Public Health. 2017 Oct 10;17(1):796. doi: 10.1186/s12889-017-4805-7.
ParentCorps is a family-centered enhancement to pre-kindergarten programming in elementary schools and early education centers. When implemented in high-poverty, urban elementary schools serving primarily Black and Latino children, it has been found to yield benefits in childhood across domains of academic achievement, behavior problems, and obesity. However, its long-term cost-effectiveness is unknown.
We determined the cost-effectiveness of ParentCorps in high-poverty, urban schools using a Markov Model projecting the long-term impact of ParentCorps compared to standard pre-kindergarten programming. We measured costs and quality adjusted life years (QALYs) resulting from the development of three disease states (i.e., drug abuse, obesity, and diabetes); from the health sequelae of these disease states; from graduation from high school; from interaction with the judiciary system; and opportunity costs of unemployment with a lifetime time horizon. The model was built, and analyses were performed in 2015-2016.
ParentCorps was estimated to save $4387 per individual and increase each individual's quality adjusted life expectancy by 0.27 QALYs. These benefits were primarily due to the impact of ParentCorps on childhood obesity and the subsequent predicted prevention of diabetes, and ParentCorps' impact on childhood behavior problems and the subsequent predicted prevention of interaction with the judiciary system and unemployment. Results were robust on sensitivity analyses, with ParentCorps remaining cost saving and health generating under nearly all assumptions, except when schools had very small pre-kindergarten programs.
Effective family-centered interventions early in life such as ParentCorps that impact academic, behavioral and health outcomes among children attending high-poverty, urban schools have the potential to result in longer-term health benefits and substantial cost savings.
ParentCorps是一种以家庭为中心的项目，旨在加强小学和早教中心的学前教育。在主要为黑人和拉丁裔儿童服务的高贫困城市小学实施该项目后，已发现其在学业成绩、行为问题和肥胖等儿童成长领域产生了益处。然而，其长期成本效益尚不清楚。
我们使用马尔可夫模型来确定ParentCorps在高贫困城市学校中的成本效益，该模型预测了ParentCorps与标准学前教育项目相比的长期影响。我们衡量了三种疾病状态（即药物滥用、肥胖和糖尿病）的发展所产生的成本和质量调整生命年（QALY）；这些疾病状态的健康后遗症；高中毕业后的情况；与司法系统的互动；以及终身失业的机会成本。该模型于2015 - 2016年构建并进行分析。
据估计，ParentCorps项目每人可节省4387美元，并使每人的质量调整预期寿命增加0.27个QALY。这些益处主要归因于ParentCorps对儿童肥胖的影响以及随后预计的糖尿病预防，以及ParentCorps对儿童行为问题的影响以及随后预计的与司法系统互动和失业的预防。敏感性分析结果稳健，除了学校的学前教育项目规模非常小时，在几乎所有假设下，ParentCorps项目仍能节省成本并产生健康效益。
早期有效的以家庭为中心的干预措施，如ParentCorps，对就读于高贫困城市学校的儿童的学业、行为和健康结果产生影响，有可能带来长期的健康益处并大幅节省成本。
