Abstract
BackgroundThe children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at reducing risk factors and addressing the needs of COPMI-families in different domains. The intervention may lead to financial consequences in the healthcare sector and in other sectors, also known as inter-sectoral costs and benefits (ICBs). The objective of this study was to assess the cost-effectiveness of PBCM from three perspectives: a narrow healthcare perspective, a social care perspective (including childcare costs) and a broad societal perspective (including all ICBs).MethodsEffects on parenting quality (as measured by the HOME) and costs during an 18-month period were studied in in a randomized controlled trial. Families received PBCM (n = 49) or care as usual (CAU) (n = 50). For all three perspectives, incremental cost-effectiveness ratios (ICERs) were calculated. Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. Sensitivity analyses included calculating ICERs excluding cost outliers, and making an adjustment for baseline cost differences.ResultsParenting quality improved in the PBCM group and declined in the CAU group, and PBCM was shown to be more costly than CAU. ICERs differ from 461 Euros (healthcare perspective) to 215 Euros (social care perspective) to 175 Euros (societal perspective) per one point improvement on the HOME T-score. The results of the sensitivity analyses, based on complete cases and excluding cost outliers, support the finding that the ICER is lower when adopting a broader perspective. The subgroup analysis and the analysis with baseline adjustments resulted in higher ICERs.ConclusionsThis study is the first economic evaluation of family-focused preventive basic care management for COPMI in psychiatric and family services. The effects of the chosen perspective on determining the cost-effectiveness of PBCM underscore the importance of economic studies of interdepartmental policies. Future studies focusing on the cost-effectiveness of programs like PBCM in other sites and studies with more power are encouraged as this may improve the quality of information used in supporting decision making.Trial registrationNTR2569, date of registration 2010-10-12.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1498-z) contains supplementary material, which is available to authorized users.
Highlights
The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development
The cost-effectiveness analyses (CEA) in this study were conducted from three perspectives: a) the healthcare perspective, which included costs for health and child/family support services, b) the social care perspective, which included costs for childcare and c) the societal perspective, which was the most comprehensive and included all measured use of services, including inter-sectoral costs and benefits (ICBs) within the educational sector, the criminal justice system and services for debt restructuring
Dropout was low in both arms (Fig. 1), namely four of the families in the Preventive basic care management (PBCM) group and three of the in the control group (χ2 = .18, df = 1, p = 0.68), and these were not related to characteristics or outcome measures
Summary
The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Children of parents with a mental illness (COPMI) have an increased risk of developing mental health disorders such as depression, anxiety disorders, personality disorders and alcohol dependence [1,2,3]. Relative risks of 1.5 to 8.0 have been found [2, 4,5,6] for COPMI in comparison with children of parents without a mental illness. Case registers of the Dutch Youth Mental Health Services show that COPMI consume five times the amount of mental healthcare than do other children, and that they are overrepresented in clinical care [8]. Epidemiological studies in the Netherlands and Norway already show one out of six to one out of three children having a parent with a mental illness [13, 14]
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