预防儿童内化问题的成本效益：在学校入学时开展 Cool Little Kids 项目的转化试验结果。

Cost-effectiveness of preventing child internalising problems: Results from the translational trial of Cool Little Kids at school entry.

机构信息

Deakin University, Deakin Health Economics, Institute for Health Transformation, Geelong, VIC, Australia.

School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.

出版信息

J Anxiety Disord. 2020 Mar;70:102191. doi: 10.1016/j.janxdis.2020.102191. Epub 2020 Jan 17.

DOI:10.1016/j.janxdis.2020.102191

PMID:32014832

Abstract

OBJECTIVE

A translational trial evaluated the effectiveness of screening for inhibited childhood temperament, followed by a preventive parenting program -Cool Little Kids. This study determined the cost-effectiveness from societal and health sector perspectives using trial data.

METHOD

Resources to deliver the screening and parenting sessions were determined from study records. Parents completed a questionnaire reporting resources used at one-year follow-up. Standard Australian unit costs were applied. Clinical outcomes for children and parental quality adjusted life-years (QALYs) were used to calculate incremental cost-effectiveness ratios (ICERs).

RESULTS

Total societal costs were lower, but non-significant for the intervention compared to the control group (mean difference -$500 p = 0.937). Total health sector costs were significantly greater (mean difference $1,956; p = 0.015). The intervention led to significantly fewer internalising symptoms (Strengths and Difficulties Questionnaire (SDQ)-emotional difficulties adjusted mean difference -0.5; p = 0.006), fewer children with SDQ-emotional symptoms in the abnormal range (24.2 % vs. 33.0 % p = .014) and fewer with diagnosed anxiety (44.2 % vs. 50.2 % p = 0.427). From the societal perspective, the intervention would likely be cost-effective. Health sector ICERs were $1,171/SDQ-emotional symptom decrease, $51/abnormal SDQ avoided and $77/anxiety case avoided.

CONCLUSIONS

This economic analysis alongside an implementation study provides an early indication that Cool Little Kids may be cost-effective.

摘要

目的

一项转化试验评估了筛查儿童抑制性气质，然后进行预防养育计划——“冷静的小家伙”的有效性。本研究从社会和卫生部门的角度，利用试验数据确定了成本效益。

方法

从研究记录中确定了提供筛查和养育课程的资源。父母在一年随访时完成了一份报告资源使用情况的问卷。应用了标准的澳大利亚单位成本。儿童的临床结果和父母的质量调整生命年（QALY）用于计算增量成本效益比（ICER）。

结果

与对照组相比，干预组的总社会成本较低，但无统计学意义（平均差异-500 美元，p=0.937）。总卫生部门成本显著增加（平均差异 1956 美元，p=0.015）。干预导致内部症状显著减少（优势和困难问卷（SDQ）-情绪困难调整平均差异-0.5，p=0.006），SDQ-情绪症状异常范围的儿童减少（24.2%对 33.0%，p=0.014），诊断出焦虑的儿童减少（44.2%对 50.2%，p=0.427）。从社会角度来看，该干预措施可能具有成本效益。从社会角度来看，卫生部门的 ICER 分别为 SDQ 情绪症状减少 1171 美元/项、避免 SDQ 异常 51 美元/项和避免焦虑 77 美元/例。