Abstract
Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the “value for money.” The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to “status quo” (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts.
Highlights
Bullying causes substantial suffering for children and adolescents
We developed a decision-analytic model in the form of a Markov cohort model to assess the cost-effectiveness of the KiVa program in comparison to status quo (i.e., Btreatment as usual^)
In a school with only grades 7–9, which is relatively common in the Swedish school context, the cost per quality adjusted life years (QALYs) was estimated at 605,000 SEK (€63,684), which is higher than the threshold value of 500,000 SEK (€52,632)
Summary
Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. There is a lack of economic evaluations of bullying prevention programs assessing the Bvalue for money.^ The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to Bstatus quo^ (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000.
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