Centre for Economics

1
Centre for Economics Policy in Health Canolfan
Economeg a Pholisi Iechyd (CEPhI) A Parenting
Programme for Children at Risk of Developing
Conduct Disorder A Cost-effectiveness Analysis
Edwards RT, Ó Céilleachair A, Bywater T , Hughes
DA Hutchings J

• What is already known?
• The costs of Conduct Disorder in childhood and
  associated costs in later life are potentially
  very great to the family, the NHS, social care
  services and the legal-justice system. Scott S,
  Knapp M, Henderson J Maughen B. Financial cost
  of social exclusion follow up study of
  anti-social children into adulthood. Br Med J
  2001 32319. Parenting is right at the top of
  the Governments policy agenda. NICE argues that
  investment in parenting programmes should be
  based on evidence of effectiveness and
  cost-effectiveness. There are a growing number of
  parenting programmes but there is limited
  rigorous evidence of their effectiveness and
  cost-effectiveness.
• Our Study- The main clinical trial is reported
  elsewhere (Hutchings etal 2007).
• Participants
• 116 children aged 36-59
• Months (87 of the
• clinical sample)
• at risk of developing
• conduct disorders as
• measured by the
• problem and
• intensity scores
• of the Eyberg
• Child Behaviour
• Index (ECBI).
• Objective

• Effects
• Behaviour of the children in the intervention
  group improved whilst the behaviour of the
  children in the control group worsened or stayed
  the same . After 6 months we observed a 17 point
  decrease on the Eyberg Child behaviour index in
  the intervention group as compared with the
  control group.
• Results
• A bootstrapped incremental cost-effectiveness
  ratio (ICER) point estimate of 73 was calculated
  per one point improvement on the intensity score
  of the ECBI (95 confidence interval 42 to
  140). It would cost 5486 to bring the child
  with the highest ECBI score to below the clinical
  cut-off point and 1344 to bring the average
  child in the intervention group within the
  non-clinical limits on the ECBI intensity score
  (below 127). For a ceiling ratio of 100 per
  point increase in ECBI score, there is a 83.9
  chance of the intervention being cost-effective
• Sensitivity Analysis
• Categorising the sample into relatively mild,
  moderate and severe groups based on Eyberg
  intensity scores at baseline it was observed that
  the intervention appeared more cost-effective in
  those with the highest risk of developing conduct
  disorder.

Figure 1 1,000 replication bootstrap
cost-effectiveness plane
Figure 2 Cost-effectiveness acceptability curve

Table 3 Total Costs IY Programme
Contact Details r.t.edwards_at_bangor.ac.uk CEPhI,
IMSCaR, Dean Street Building, University of
Wales, Bangor,LL57 1UT Gwynedd, Wales  
Project is supported by the Health Foundation And
is an accepted Publication BMJ 2007