Department of Public Health and Caring Sciences (IFV), Uppsala University, BMC, Husargatan 3, 751 22, Uppsala, Sweden.
Epigear International, Sunrise Beach, QLD, Australia.
Eur Child Adolesc Psychiatry. 2018 Jul;27(7):933-944. doi: 10.1007/s00787-017-1100-1. Epub 2017 Dec 29.
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.
养育计划是治疗儿童品行障碍(CD)的推荐疗法,但对于其长期成本效益知之甚少。本研究旨在评估一种研究最多的循证养育计划——三重 P-积极养育计划的人群成本效益,该计划以小组和个体形式提供,用于治疗儿童 CD。从卫生部门的角度出发,开发了一个基于人群的多队列决策分析模型,以估计与“无干预”情景相比,三重 P 方案每避免一个残疾调整生命年(DALY)的成本。该模型针对的是澳大利亚目前正在寻求治疗的 5-9 岁 CD 儿童队列,并对他们进行了跟踪,直到他们成年(即 18 岁)。进行了多变量概率和单变量敏感性分析,以纳入模型参数中的不确定性。当以小组形式提供时,三重 P 方案比无干预方案在每避免一个 DALY 的成本效益高 50,000 澳元的阈值时具有成本效益(增量成本效益比(ICER)为每避免一个 DALY 花费 1013 澳元;95%置信区间(UI)为 471-1956),以个体形式提供时(ICER 为每避免一个 DALY 花费 20,498 澳元;95% UI 为 11,146-39,470)。对于儿童 CD 的治疗,如三重 P 等基于证据的养育计划,以小组或个体面对面形式提供时,似乎具有良好的性价比,其中小组形式是最具成本效益的选择。该模型可用于针对 CD 的其他干预措施的经济评估以及其他环境。