Adding the Coping Power Programme to parent management training: the cost-effectiveness of stacking interventions for children with disruptive behaviour disorders

Camilla Nystrand,Maria Helander,Inna Feldman,Filipa Sampaio,Pia Enebrink

doi:10.1007/s00787-020-01638-w

Abstract

Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8–12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015

Highlights

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder, characterised by oppositional, argumentative behaviour, angry, irritable mood, or vindictiveness lasting for at least six months [1]
The probability of a “recovered” case of ODD was higher in the Comet with Coping Power Programme (CPP) group, in comparison to Comet only [odds ratio of 1.70] at the 2-year follow-up
Differences in quality-adjusted life-years (QALYs) gains between the two arms were small in magnitude, Comet with CPP showing lower QALY gains [0.0008 for Comet only]

Summary

Introduction

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder, characterised by oppositional, argumentative behaviour, angry, irritable mood, or vindictiveness lasting for at least six months [1]. Preparation time + time after each session Individual meetings Cost of venue Cost of materials (per group) Refreshements Total per group Total for all groups in the study (n = 14) Total for implementation in clinical practice (n = 20)a Total cost for the study. Training + delivery Cost/child for the children that started CPP (n = 58) (training + delivery) Cost/child for those who participated in 80% (< 12 sessions) of CPP (n = 37). Total cost if implemented in clinical practice Training + delivery. The amount of children that would receive the intervention if implemented in clinical practice = 120 The cost for a group session differs from the cost of preparation/time spent after session, as well as the individual meetings, due to differing rates. A recall period of three months was assumed, since it has been suggested as the optimal length [45]

Methods

Results

Conclusion