基于学校的社会情感学习干预的成本效益：促进替代思维策略课程的集群随机对照试验的证据。

Cost-Effectiveness of a School-Based Social and Emotional Learning Intervention: Evidence from a Cluster-Randomised Controlled Trial of the Promoting Alternative Thinking Strategies Curriculum.

机构信息

Centre for Primary Care and Health Services Research, The University of Manchester, Suite 6 Williamson Building, Oxford Road, Manchester, M13 9QQ, UK.

Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.

出版信息

Appl Health Econ Health Policy. 2020 Apr;18(2):271-285. doi: 10.1007/s40258-019-00498-z.

DOI:10.1007/s40258-019-00498-z

PMID:31347016

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7085485/

Abstract

BACKGROUND

School-based social and emotional learning interventions can improve wellbeing and educational attainment in childhood. However, there is no evidence on their effects on health-related quality of life (HRQoL) or on their cost effectiveness.

OBJECTIVE

Our objective was to evaluate the cost effectiveness of the Promoting Alternative Thinking Strategies (PATHS) curriculum.

METHODS

A prospective economic evaluation was conducted alongside a cluster-randomised controlled trial of the PATHS curriculum implemented in the Greater Manchester area of England. In total, 23 schools (n = 2676 children) were randomised to receive PATHS, and 22 schools (n = 2542 children) were randomised to continue with usual practice. A UK health service perspective and a 2-year time horizon were used. HRQoL data were collected prospectively from all children in the trial via the Child Health Utility Nine-Dimension questionnaire. Micro-costing was undertaken to estimate the intervention costs. Missing data were imputed using multiple imputation.

RESULTS

The mean incremental cost of the PATHS curriculum compared with usual practice was £32.01 per child, and mean incremental quality-adjusted life-years (QALYs) were positive (0.0019; 95% confidence interval [CI] 0.0009-0.0029). Assuming a willingness-to-pay threshold of £20,000 per QALY, the expected incremental net benefit of introducing the PATHS curriculum was £5.56 per child (95% CI - 14.68 to 25.81), and the probability of cost effectiveness was 84%. However, this probability fell to 0% when intervention costs included teacher's salary costs.

CONCLUSION

The PATHS curriculum has the potential to be cost effective at standard UK willingness-to-pay thresholds. However, the sensitivity of the cost-effectiveness estimates to key assumptions means decision makers should seek further information before allocating scarce public resources.

TRIAL REGISTRATION NUMBER

ISRCTN85087674.

摘要

背景

基于学校的社会情感学习干预措施可以改善儿童的幸福感和教育成就。然而，目前尚无证据表明其对健康相关生活质量（HRQoL）或成本效益有影响。

目的

我们旨在评估促进替代思维策略（PATHS）课程的成本效益。

方法

在英格兰大曼彻斯特地区实施 PATHS 课程的集群随机对照试验中，同时进行了前瞻性经济评估。共有 23 所学校（n=2676 名儿童）被随机分配接受 PATHS，22 所学校（n=2542 名儿童）继续采用常规做法。使用英国卫生服务视角和 2 年时间范围。通过儿童健康效用九维度问卷从试验中的所有儿童前瞻性收集 HRQoL 数据。采用微观成本法估算干预成本。使用多重插补法处理缺失数据。

结果

与常规做法相比，PATHS 课程的平均增量成本为每个儿童 32.01 英镑，平均增量质量调整生命年（QALY）为正值（0.0019；95%置信区间[CI] 0.0009-0.0029）。假设每 QALY 支付意愿阈值为 20,000 英镑，引入 PATHS 课程的预期增量净效益为每个儿童 5.56 英镑（95%CI-14.68 至 25.81），成本效益的概率为 84%。然而，当干预成本包括教师工资成本时，这种概率降至 0%。