An Economic Evaluation of the Incredible Years Toddler Parenting Programme

1
An Economic Evaluation of the Incredible Years
Toddler Parenting Programme An Update

• Joanna Charles

Supervised by Prof. Rhiannon Tudor Edwards and
Dr. Tracey Bywater
2
Conduct Disorder Costs

• Conduct disorders cost the public health system
  significantly Knapp et al. (1999) found 30 of
  child consultations with general practitioners
  were for CD.
• Knapp et al. (1999) also found the cost of
  treating a child with CD on the NHS was 2457.
• Scott et al. 2001 found that the cost of public
  services for those aged 28 years with CD in
  childhood was 10 times higher, 70,019 than those
  with no history of CD, 7,423 therefore it is
  imperative to find a cost-effective solution to
  treat CD to ease the strain on the NHS.

3
Social and Emotional Competence

• Social competence refers to the group of social,
  emotional and cognitive behaviours/skills that
  children need in order to adapt successfully to
  social situations (Welsh Bierman, 2001).
• Emotional competence refers to the ability to
  express ones emotions and successfully interpret
  the emotions of others (Welsh Bierman, 2001).
• Social and emotional competence has shown to be a
  protective factor against CD

4
My PhD

• Previous research has shown the Incredible Years
  BASIC Parenting Programme to be cost effective in
  treating CD in children aged between 3-4 years,
  Edwards et al. 2007.
• It is important to tackle conduct disorder early
  as it can have damaging effects on social
  relationships, well being, education and future
  prospects, Rutter and Giller (1983).
• Robins (1966) found 40-50 of children with CD go
  on to develop anti-social personality as adults.
  Research has also found a link between child CD
  and adult anti-social behaviour e.g. theft,
  violence, drunk driving, illegal drug use, group
  violence, carrying and/or using weapons,
  Farrington (1995).

5
Evaluating the cost-effectiveness of the
Incredible Years Toddler Parenting Programme

• 78 mothers and their toddlers, 1-3 years old (53
  intervention and 25 control), were accessed at
  their 6 and 12 month follow-up from the main
  Randomised Controlled Trial conducted by Nia
  Griffith, and asked to complete additional
  economic measures.
• The EQ-5D (Kind et al., 1995) and the Client
  Receipt Service Inventory (CRSI) (Chisholm et
  al., 2000).
• Eighteen Group leaders were asked to complete a
  weekly cost diary over the 12 week delivery of
  the programme, to establish the costs of running
  a group.

6
Parents Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 3.4 123.11 2.2 66.32 1.8 55.66 2.3 71.00
Social services 0.2 7.62 0.04 1.24 0.1 36.88 0 0.00
Hospital Services 1.0 207.50 0.6 114.08 0.5 99.05 0.2 34.30
Total 4.6 338.23 2.84 181.64 2.4 191.59 2.5 105.30
Change over 6 months ----- ----- ----- ----- 2.4 - 4.6 -2.2 191.59 338.23 -146.64 2.5 2.84 -0.34 105.30 181.64 -76.34
7
Parents Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 3.4 123.11 2.2 66.32 1.8 55.66 2.3 71.00
Social services 0.2 7.62 0.04 1.24 0.1 36.88 0 0.00
Hospital Services 1.0 207.50 0.6 114.08 0.5 99.05 0.2 34.30
Total 4.6 338.23 2.84 181.64 2.4 191.59 2.5 105.30
Change over 6 months ----- ----- ----- ----- 2.4 - 4.6 -2.2 191.59 338.23 -146.64 2.5 2.84 -0.34 105.30 181.64 -76.34
8
Parents Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 3.4 123.11 2.2 66.32 1.8 55.66 2.3 71.00
Social services 0.2 7.62 0.04 1.24 0.1 36.88 0 0.00
Hospital Services 1.0 207.50 0.6 114.08 0.5 99.05 0.2 34.30
Total 4.6 338.23 2.84 181.64 2.4 191.59 2.5 105.30
Change over 6 months ----- ----- ----- ----- 2.4 - 4.6 -2.2 191.59 338.23 -146.64 2.5 2.84 -0.34 105.30 181.64 -76.34
9
Parents Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 3.4 123.11 2.2 66.32 1.8 55.66 2.3 71.00
Social services 0.2 7.62 0.04 1.24 0.1 36.88 0 0.00
Hospital Services 1.0 207.50 0.6 114.08 0.5 99.05 0.2 34.30
Total 4.6 338.23 2.84 181.64 2.4 191.59 2.5 105.30
Change over 6 months ----- ----- ----- ----- 2.4 - 4.6 -2.2 191.59 338.23 -146.64 2.5 2.84 -0.34 105.30 181.64 -76.34
10
Parents Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 3.4 123.11 2.2 66.32 1.8 55.66 2.3 71.00
Social services 0.2 7.62 0.04 1.24 0.1 36.88 0 0.00
Hospital Services 1.0 207.50 0.6 114.08 0.5 99.05 0.2 34.30
Total 4.6 338.23 2.84 181.64 2.4 191.59 2.5 105.30
Change over 6 months ----- ----- ----- ----- 2.4 - 4.6 -2.2 191.59 338.23 -146.64 2.5 2.84 -0.34 105.30 181.64 -76.34
11
Childrens Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 4.3 187.75 2.9 104.04 2.6 109.58 3.3 119.80
Social services 5.3 28.92 0.2 43.88 0.2 17.82 0.2 22.50
Hospital Services 0.7 107.08 0.4 57.80 0.6 86.89 0.3 186.70
Total 10.3 323.75 3.5 205.72 3.4 214.29 3.8 329.00
Change over 6 months ----- ----- ----- ----- 3.4 10.3 -6.9 214.29 323.75 -109.46 3.8 3.5 0.3 329.00 - 205.72 123.28
12
Childrens Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 4.3 187.75 2.9 104.04 2.6 109.58 3.3 119.80
Social services 5.3 28.92 0.2 43.88 0.2 17.82 0.2 22.50
Hospital Services 0.7 107.08 0.4 57.80 0.6 86.89 0.3 186.70
Total 10.3 323.75 3.5 205.72 3.4 214.29 3.8 329.00
Change over 6 months ----- ----- ----- ----- 3.4 10.3 -6.9 214.29 323.75 -109.46 3.8 3.5 0.3 329.00 - 205.72 123.28
13
Childrens Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 4.3 187.75 2.9 104.04 2.6 109.58 3.3 119.80
Social services 5.3 28.92 0.2 43.88 0.2 17.82 0.2 22.50
Hospital Services 0.7 107.08 0.4 57.80 0.6 86.89 0.3 186.70
Total 10.3 323.75 3.5 205.72 3.4 214.29 3.8 329.00
Change over 6 months ----- ----- ----- ----- 3.4 10.3 -6.9 214.29 323.75 -109.46 3.8 3.5 0.3 329.00 - 205.72 123.28
14
Childrens Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 4.3 187.75 2.9 104.04 2.6 109.58 3.3 119.80
Social services 5.3 28.92 0.2 43.88 0.2 17.82 0.2 22.50
Hospital Services 0.7 107.08 0.4 57.80 0.6 86.89 0.3 186.70
Total 10.3 323.75 3.5 205.72 3.4 214.29 3.8 329.00
Change over 6 months ----- ----- ----- ----- 3.4 10.3 -6.9 214.29 323.75 -109.46 3.8 3.5 0.3 329.00 - 205.72 123.28
15
Childrens Service Use
Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline) Time point 2 (12 months post-baseline)
Intervention (N53) Intervention (N53) Control (N25) Control (N25) Intervention (N38) Intervention (N38) Control (N10) Control (N10)
Type of service Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean Cost
Primary care 4.3 187.75 2.9 104.04 2.6 109.58 3.3 119.80
Social services 5.3 28.92 0.2 43.88 0.2 17.82 0.2 22.50
Hospital Services 0.7 107.08 0.4 57.80 0.6 86.89 0.3 186.70
Total 10.3 323.75 3.5 205.72 3.4 214.29 3.8 329.00
Change over 6 months ----- ----- ----- ----- 3.4 10.3 -6.9 214.29 323.75 -109.46 3.8 3.5 0.3 329.00 - 205.72 123.28
16
Summary of Findings

• This is a small data set compared with the main
  trials sample. Therefore it is important to be
  aware of the general representativeness of the
  results and any bias.
• The sample would not be considered heavy service
  users
• Parents Service Use
• Mean frequencies and costs of service use for
  both the intervention and control groups are
  relatively small and decreased at 12 months
  post-baseline.
• Childrens Service Use
• Mean frequencies and costs of service use for the
  intervention group again are relatively small and
  decreased at 12 months post-baseline. Mean
  frequencies and costs of service use for the
  control group increased slightly at 12 months
  post-baseline.

17
Upcoming Analysis

• We will calculate a cost-effectiveness ratio by
  dividing the mean cost by the mean effect for
  both intervention and control groups to show the
  probability that this parenting programme is
  good-value for money, with comparison to previous
  work such as Edwards et als work on the BASIC
  programme.
• We will establish if service use and therefore
  costs of service use decreases after attending a
  parenting programme and cost a 1 point
  improvement on the BDI (Beck et al. 1961) to
  bring parental depression below clinical cut-off
  and a cost per unit of improvement on the
  Schedule of Growing Skills, SGS II (Bellman et
  al., 1997).