Nystrand Camilla, Sampaio Filipa, Hoch Jeffrey S, Osman Fatumo, Feldman Inna
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA, USA.
Cost Eff Resour Alloc. 2021 Apr 23;19(1):23. doi: 10.1186/s12962-021-00278-4.
Parenting programs can be economically attractive interventions for improving the mental health of both parents and their children. Few attempts have been made to analyse the value of children's and parent's outcomes simultaneously, to provide a qualified support for decision making.
A within trial cost-effectiveness evaluation was conducted, comparing Ladnaan, a culturally tailored parenting program for Somali-born parents, with a waitlist control. Quality-adjusted life years (QALY) for parents were estimated by mapping the General Health Questionnaire-12 to Euroqol's EQ-5D-3L to retrieve utilities. Behavioural problems in children were measured using the Child Behaviour Checklist (CBCL). Intervention costs were estimated for the trial. A net benefit regression framework was employed to study the cost-effectiveness of the intervention, dealing with multiple effects in the same analysis to estimate different combinations of willingness-to pay (WTP) thresholds.
For a WTP of roughly €300 for a one point improvement in total problems on the CBCL scale (children), Ladnaan is cost-effective. In contrast, the WTP would have to be roughly €580,000 per QALY (parents) for it to be cost-effective. Various combinations of WTP values for the two outcomes (i.e., CBCL and QALY) may be used to describe other scenarios where Ladnaan is cost-effective.
Decision-makers interested in multiple effects must take into account combinations of effects in relation to budget, in order to obtain cost-effective results. A culturally adapted parenting program may be cost-effective, depending on the primary outcome, or multiple outcomes of interest. Trial registration clinicaltrials.gov, NCT02114593. Registered 15 April 2014-prospectively registered, https://www.clinicaltrials.gov/ct2/results?recrs=&cond=&term=NCT02114593&cntry=&state=&city=&dist=.
育儿项目对于改善父母及其子女的心理健康而言，可能是具有经济吸引力的干预措施。很少有人尝试同时分析儿童和父母的结果价值，以便为决策提供有依据的支持。
进行了一项试验内成本效益评估，将针对索马里出生的父母量身定制的文化适应性育儿项目“拉德南”（Ladnaan）与等待名单对照组进行比较。通过将一般健康问卷-12映射到欧洲生活质量量表EQ-5D-3L以获取效用值，来估计父母的质量调整生命年（QALY）。使用儿童行为清单（CBCL）测量儿童的行为问题。估算了该试验的干预成本。采用净效益回归框架来研究干预措施的成本效益，在同一分析中处理多种效应，以估计不同支付意愿（WTP）阈值的组合。
对于儿童CBCL量表上总问题每改善1分，支付意愿约为300欧元时，“拉德南”具有成本效益。相比之下，对于父母而言，每获得1个QALY，支付意愿约为580,000欧元时，该项目才具有成本效益。两种结果（即CBCL和QALY）的不同WTP值组合可用于描述“拉德南”具有成本效益的其他情况。
对多种效应感兴趣的决策者必须考虑与预算相关的效应组合，以获得具有成本效益的结果。根据主要结果或感兴趣的多个结果，一个文化适应性的育儿项目可能具有成本效益。试验注册 clinicaltrials.gov，NCT02114593。2014年4月15日注册——前瞻性注册，https://www.clinicaltrials.gov/ct2/results?recrs=&cond=&term=NCT02114593&cntry=&state=&city=&dist= 。
