Abstract
BackgroundParenting 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.MethodsA 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.ResultsFor 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.ConclusionsDecision-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=
Highlights
Parenting programs can be economically attractive interventions for improving the mental health of both parents and their children
There is a wide range of research on including spillover effects in effectiveness evaluations, including effects on different outcomes related to health, employment and schooling
An approach developed to overcome this difficulty is the incremental net benefit (INB) framework, as it may be applied in the case of clinical outcomes or while combining two different measures of effectiveness [13]
Summary
Parenting programs can be economically attractive interventions for improving the mental health of both parents and their children. Few studies have attempted to simultaneously assess health outcomes that are generic and clinical This approach is interesting in relation to a decision-maker’s willingness-to-pay (WTP) for different outcomes. National and international health technology assessment organizations recommend levels at which new treatments would be deemed good value for money, i.e. cost-effective [10, 11]. The World Health Organization recommends a WTP level of less than three times the national annual gross domestic product per capita [12]. These recommended values could be used as shadow estimates for the WTP for a generic outcome. An approach developed to overcome this difficulty is the incremental net benefit (INB) framework, as it may be applied in the case of clinical outcomes or while combining two different measures of effectiveness [13]
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