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Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial
Henny J Wansink1, Ruben M W A Drost2, Aggie T G Paulus2
1Context, Prevention Department of the Parnassia Group, Lijnbaan 4, The Hague, 2512 VA, The Netherlands. h.wansink@indigohaaglanden.nl.
Insights
Preventive basic care management (PBCM) improves parenting quality for children of parents with mental illness (COPMI). A broader societal perspective reveals PBCM is more cost-effective than standard care.
Area of Science:
- Child Development
- Mental Health Services
- Health Economics
Background:
- Children of parents with mental illness (COPMI) face increased risks for psychiatric disorders.
- Risk factors can negatively impact parenting quality and child development.
- Preventive basic care management (PBCM) aims to mitigate these risks for COPMI families.
Purpose of the Study:
- To assess the cost-effectiveness of PBCM for COPMI families.
- To evaluate PBCM from healthcare, social care, and societal perspectives.
- To understand the inter-sectoral costs and benefits (ICBs) of PBCM.
Main Methods:
- A randomized controlled trial compared PBCM (n=49) with care as usual (CAU) (n=50).
- Parenting quality (HOME T-score) and costs were measured over 18 months.
- Incremental cost-effectiveness ratios (ICERs) were calculated using bootstraps and sensitivity analyses.
Main Results:
- Parenting quality improved with PBCM and declined with CAU.
- PBCM incurred higher costs than CAU.
- ICERs per HOME T-score point were €461 (healthcare), €215 (social care), and €175 (societal).
Conclusions:
- PBCM is a cost-effective intervention for COPMI families, particularly from a societal perspective.
- The chosen economic perspective significantly influences cost-effectiveness findings.
- Further economic evaluations and larger studies are recommended to support decision-making for interdepartmental policies.
Background:
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. 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).
Methods:
Effects 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.
Results:
Parenting 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.
Conclusions:
This 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 Registration:
NTR2569 , date of registration 2010-10-12.
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