Top

BMC Health Services Research

Published in:

Open Access 01-12-2024 | Research

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

Authors: Gráinne E. Crealey, Gráinne Hickey, Sinead McGilloway

Published in: BMC Health Services Research | Issue 1/2024

Abstract

Background

This study assessed whether a relatively newly developed Parent and Infant (PIN) parenting support programme was cost-effective when compared to services as usual (SAU).

Methods

The cost-effectiveness of the PIN programme versus SAU was assessed from an Irish health and social care perspective over a 24-month timeframe and within the context of a non-randomised, controlled before-and-after trial. In total, 163 parent-infant dyads were included in the study (86 intervention, 77 control). The primary outcome measure for the economic evaluation was the Parenting Sense of Competence Scale (PSOC).

Results

The average cost of the PIN programme was €647 per dyad. The mean (SE) cost (including programme costs) was €7,027 (SE €1,345) compared to €4,811 (SE €593) in the control arm, generating a (non-significant) mean cost difference of €2,216 (bootstrap 95% CI -€665 to €5,096; p = 0.14). The mean incremental cost-effectiveness of the PIN service was €614 per PSOC unit gained (bootstrap 95% CI €54 to €1,481). The probability that the PIN programme was cost-effective, was 87% at a willingness-to-pay of €1,000 per one unit change in the PSOC.

Conclusions

Our findings suggest that the PIN programme was cost-effective at a relatively low willingness-to-pay threshold when compared to SAU. This study addresses a significant knowledge gap in the field of early intervention by providing important real world evidence on the implementation costs and cost-effectiveness of a universal early years parenting programme. The challenges involved in assessing the cost-effectiveness of preventative interventions for very young children and their parents are also discussed.

Trial registration

ISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.

Available only for authorised users

Belsky J, Beaver KM. Cumulative-genetic plasticity, parenting and adolescent self-regulation. JCCP. 2011;52:619–26.

Banella FE, Tronick E. Mutual regulation and unique forms of implicit relational knowing. In: Apter, G., Devouche, E., Gratier, M. (eds) Early Interaction and Developmental Psychopathology. Springer, Cham. https://doi.org/10.1007/978-3-030-04769-6_3.

Peckins MK, Roberts AG, Hein TC, Hyde LW, Mitchell C, Brooks-Gunn J, Lopez-Duran NL. Violence exposure and social deprivation is associated with cortisol reactivity in urban adolescents. Psychoneuroendocrinology. 2020;111:104426.PubMedCrossRef

Hein TC, Monk CS. Research Review: Neural response to threat in children, adolescents, and adults after child maltreatment–a quantitative meta-analysis. JCPP. 2017;58:222–30.PubMed

Kaul D, Schwab SG, Mechawar N, Matosin N. How stress physically re-shapes the brain: Impact on brain cell shapes, numbers and connections in psychiatric disorders. Neurosci Biobehav Rev. 2021;124:193–215.PubMedCrossRef

Lorber MF, Egeland B. Parenting and infant difficulty. Child Dev. 2011;82:2006–20.PubMedCrossRef

Bellis MA, Hardcastle K, Ford K, Hughes K, Ashton K, Quigg Z, Butler N. Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences-a retrospective study on adult health-harming behaviours and mental well-being. BMC Psychiatry. 2017;17:1–12.

Heckman JJ, Corbin CO. Capabilities and skills. J Hum Dev Cap. 2016;17:342–59.

Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, Perez-Escamilla R, Rao N, Ip P, Fernald LCH, MacMillan H, Hanson M, Wachs TD, Yao H, Yoshikawa H, Cerezo A, Leckman JF, Bhutta ZA. Early Childhood Development Interventions Review Group, for the Lancet Early Childhood Development Series Steering Committee. Nurturing care: promoting early childhood development. Lancet. 2017;389(10064):91–102. https://doi.org/10.1016/S0140-6736(16)31390-3. Epub 2016 Oct 4.

10.

Charles JM, Bywater T, Edwards RT. Parenting interventions: a systematic review of the economic evidence. Child Care Health Dev. 2011;37:462–74.PubMedCrossRef

11.

Duncan KM, MacGillivray S, Renfrew MJ. Costs and savings of parenting interventions: results of a systematic review. Child Care Health Dev. 2017;43:797–811.PubMedCrossRef

12.

McGilloway S, NiMhaille G, Bywater T, Leckey Y, et al. Reducing child conduct disordered behaviour and improving parent mental health in disadvantaged families: a 12-month follow-up and cost analysis of a parenting intervention. ECAP. 2014;23:783–94.

13.

O’Neill D, McGilloway S, Donnelly M, Bywater T, Kelly P. A cost-effectiveness analysis of the incredible years parenting programme in reducing childhood health inequalities. Eur J Health Econ. 2013;14:85–94.PubMedCrossRef

14.

Sampaio F, Nystrand C, Feldman I, Mihalopoulos C. Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations. Eur Child Adolesc Psychiatry. 2022. https://doi.org/10.1007/s00787-022-01969-w. Epub ahead of print.

15.

Stevens M. The cost-effectiveness of UK parenting programmes for preventing children’s behaviour problems–a review of the evidence. Child Fam Soc Work. 2014;19:109–18.CrossRef

16.

Trillingsgaard T, Maimburg RD, Simonsen M. The Family Startup Program: study protocol for a randomized controlled trial of a universal group-based parenting support program. BMC Public Health. 2015;15(1):1.CrossRef

17.

Cullen SM, Cullen MA, Lindsay G. Universal parenting programme provision in England; barriers to parent engagement in the CAN parent trial, 2012–2014. Child Soc. 2016;30(1):71–81.CrossRef

18.

Lindsay G, Totsika V. The effectiveness of universal parenting programmes: The CANparent trial. BMC Psych. 2017;5:35.CrossRef

19.

Simkiss DE, Snooks HA, Stallard N, Kimani PK, Sewell B, et al. Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities: multicentre randomised controlled trial. BMJ Open. 2013;3:e002851.PubMedPubMedCentralCrossRef

20.

Hurt L, Paranjothy S, Lucas PJ, Watson D, Mann M, et al. Interventions that enhance health services for parents and infants to improve child development and social and emotional well-being in high income countries: A systematic review. BMJ Open. 2018;8:e014899. https://doi.org/10.1136/bmjopen-2016-014899.CrossRefPubMedPubMedCentral

21.

Hiscock H, Bayer JK, Price A, Ukoumunne OC, Rogers S, Wake M. Universal parenting programme to prevent early childhood behavioural problems: cluster randomized trial. BMJ. 2008;336:318–21.PubMedPubMedCentralCrossRef

22.

Bayer JK, Hiscock H, Ukoumunne OC, Scalzo K, Wake M. Three-year old outcomes of a brief universal parenting intervention to prevent behavior problems: randomized controlled trial. Arc Dis Child. 2010;95:187-.CrossRef

23.

Pontoppidan M, Klest SK, Patras J, Rayce SB. Effects of universally offered parenting interventions for parents with infants: a systematic review. BMJ Open. 2016;6:e011706.PubMedPubMedCentralCrossRef

24.

Barlow J, Parsons J, Stewart-Brown S. Preventing emotional and behavioural problems: the effectiveness of parenting programmes with children less than 3 years of age. Child Care Health Dev. 2005;31(1):33–42.PubMedCrossRef

25.

Shi H, Li X, Fang H, Zhang J, Wang X. The effectiveness and cost-effectiveness of a parenting intervention integrated with primary health care on early childhood development: a cluster-randomized controlled trial. Prev Sci. 2020;21:661–71.PubMedCrossRef

26.

Bywater T, Berry V, Blower S, Bursnall M, Cox E, et al. A randomized controlled trial of a proportionate universal parenting program delivery model (E-SEE Steps) to enhance child social-emotional wellbeing. PloS One. 2022;17:e0265200.PubMedPubMedCentralCrossRef

27.

Barnes J, Stuart J, Allen E, Petrou S, Sturgess J, Barlow J, Macdonald G, Spiby H, Aistrop D, Melhuish E, Kim SW, Elbourne D. Randomized controlled trial and economic evaluation of nurse-led group support for young mothers during pregnancy and the first year postpartum versus usual care. Trials. 2017;18(1):508. https://doi.org/10.1186/s13063-017-2259-y.

28.

Ulfsdotter M, Lindberg L, Månsdotter A. A cost-effectiveness analysis of the Swedish universal parenting program all children in focus. PLoS One. 2015;10:e0145201.PubMedPubMedCentralCrossRef

29.

Cox E, Walker S, Blower S, Sampaio F, Bywater T, Richardson G. The cost-effectiveness of a proportionate parenting programme for primary caregivers and their child: an economic evaluation using evidence from the E-SEE Trial. BMC Health Serv Res. 2022;22:1–10.CrossRef

30.

van Aar J, Leijten P, de Castro BO, Overbeek G. Sustained, fade-out or sleeper effects? A systematic review and meta-analysis of parenting interventions for disruptive child behavior. Clin Psych Rev. 2017;51:153–63.CrossRef

31.

Hickey G, McGilloway S, Leckey Y, Leavy S, Stokes A, O’Connor S, Donnelly M, Bywater T. Exploring the potential utility and impact of a universal, multicomponent early parenting intervention through a community-based controlled trial. Child Youth Serv Rev. 2020:118. https://doi.org/10.1016/j.childyouth.2020.105458.

32.

Beecham J, Knap M. Costing psychiatric interventions. In: Thornicroft G, Brewin C, Wingm J, editors. Measuring mental health needs. London: Gaskill; 1992. p. 179–90.

33.

Health Information and Quality Authority. Guidelines for the economic evaluation of health technologies in Ireland. 2020. https://www.hiqa.ie/reports-and-publications/health-technology-assessment/guide-health-technology-assessment-hiqa.

34.

Albanese AM, Russo GR, Geller PA. The role of parental self-efficacy in parent and child well-being: A systematic review of associated outcomes. Child Care Health Dev. 2019;45:333–63.PubMedCrossRef

35.

Ayala-Nunes L, Lemos I, Nunes C. Parenting stress predictors in mothers of families at psychosocial risk. Universitas Psychologica. 2014;13:529–39.

36.

Begle AM, Dumas JE. Child and parental outcomes following involvement in a preventive intervention: Efficacy of the PACE program. J Prim Prev. 2011;32:67–81.PubMedPubMedCentralCrossRef

37.

Bloomfield L, Kendall S. Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme. Prim Health Care Res Dev. 2012;13:364–72.PubMedCrossRef

38.

Coleman PK, Karraker KH. Parenting self-efficacy among mothers of school-age children: Conceptualization, measurement, and correlates. Fam Relat. 2000;49:13–24.CrossRef

39.

Jones TL, Prinz RJ. Potential roles of parental self-efficacy in parent and child adjustment: A review. Clin Psych Rev. 2005;25:341–63.CrossRef

40.

Law KH, Dimmock J, Guelfi KJ, Nguyen T, Gucciardi D, Jackson B. Stress, depressive symptoms, and maternal self-efficacy in first-time mothers: Modelling and predicting change across the first six months of motherhood. App Psych Health Well-being. 2019;11:126–47.CrossRef

41.

Leahy-Warren P, McCarthy G. Maternal parental self-efficacy in the postpartum period. Midwifery. 2011;27:802–10.PubMedCrossRef

42.

Teti DM, Candelaria MA. Parenting Competence. In: Bornstein MH, editor. Handbook of parenting, vol. 4. Social conditions and applied parenting. Mahwah, NJ: Erlbaum; 2012. p. 149–80.

43.

Seetharaman M, Benjamin A, McGrath JM, Vance AJ. Parenting self-efficacy instruments for parents of infants and toddlers: A review. Int J Nur Stud Adv. 2022;4. Article 100082. https://doi.org/10.1016/j.ijnsa.2022.100082.

44.

Wittkowski A, Garrett C, Calam R, Weisberg D. Self-report measures of parental self-efficacy: A systematic review of the current literature. J Child Fam Stud. 2017;26:2960–78.PubMedPubMedCentralCrossRef

45.

Johnston C, Mash EJ. A measure of parenting satisfaction and efficacy. JCCP. 1989;18:167–75.

46.

Carneiro P, Galazzo E, López-García I, Bedregal P, Cordero M. Parental beliefs, investments and child development: Evidence from a large-scale experiment. Bonn: IZA Institute of Labour Economics; 2019. IZA DP No. 12506.CrossRef

47.

Deković M, Asscher JJ, Hermanns J, Reitz E, Prinzie P, Van Den Akker AL. Tracing changes in families who participated in the home-start parenting program: Parental sense of competence as mechanism of change. Prev Sci. 2010;11:263–74.PubMedPubMedCentralCrossRef

48.

Tuntipuchitanon S, Kangwanthiti IO, Jirakran K, Trairatvorakul P, Chonchaiya W. Online positive parenting programme for promoting parenting competencies and skills: randomised controlled trial. Sci Rep. 2022;12:1–12.CrossRef

49.

Deković M, Asscher JJ, Manders WA, van der Prins PJ, Laan P. Within-intervention change: mediators of intervention effects during multisystemic therapy. JCCP. 2012;80:574.

50.

Högström J, Olofsson V, Özdemir M, Enebrink P, Stattin H. Two-year findings from a national effectiveness trial: Effectiveness of behavioral and non-behavioral parenting programs. J Ab Child Psych. 2017;45:527–42.CrossRef

51.

Karp SM, Lutenbacher M, Wallston KA. Evaluation of the parenting sense of competence scale in mothers of infants. J Child Fam Stud. 2015;24:3474–81.CrossRef

52.

Verstraete J, Ramma L, Jelsma J. Item generation for a proxy health related quality of life measure in very young children. Health Qual Life Outcomes. 2020;14:11. https://doi.org/10.1186/s12955-020-1271-1.CrossRef

53.

Petrou S. Methodological challenges surrounding QALY estimation for paediatric economic evaluation. Cost Eff Resour Alloc. 2022;20(1):10.PubMedPubMedCentralCrossRef

54.

Van Breukelen GJ. ANCOVA versus change from baseline had more power in randomized studies and more bias in nonrandomized studies. J Clin Epidemiol. 2006;59:920–5.PubMedCrossRef

55.

Van Breukelen GJ. ANCOVA versus CHANGE from baseline in nonrandomized studies: The difference. Multivariate Behav Res. 2013;48:895–922.PubMedCrossRef

56.

Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E, ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated health economic evaluation reporting standards (CHEERS)–explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health. 2013;16:231–50. https://doi.org/10.1016/j.jval.2013.02.002.CrossRefPubMed

57.

Jakobsen JC, Gluud C, Wetterslev J, Winkel P. When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guide with flowcharts. BMC Med Res Methodol. 2017;17:162. https://doi.org/10.1186/s12874-017-0442-1.CrossRefPubMedPubMedCentral

58.

Glatz T, Lippold M, Chung G, Jensen TM. A systematic review of parental self-efficacy among parents of school-age children and adolescents. Adoles Res Rev. 2023;6:1–7.

59.

Fang Y, Boelens M, Windhorst DA, Raat H, vanGrieken A. Factors associated with parenting self-efficacy: A systematic review. J Adv Nurs. 2021;77:2641–61.PubMedPubMedCentralCrossRef

60.

Gardner F, Leijten P, Mann J, Landau S, Harris V, Beecham J, Bonin EM, Hutchings J, Scott S. Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective. Southampton (UK): NIHR Journals Library; 2017.

61.

Edwards RT, Jones C, Berry V, Charles J, Linck P, Bywater T, Hutchings J. Incredible years parenting programme: cost-effectiveness and implementation. J Child Serv. 2016;11:54–72.CrossRef

62.

Charles JM, Bywater TJ, Edwards RT, Hutchings J, Zou L. Parental depression and child conduct problems: evaluation of parental service use and associated costs after attending the incredible years basic parenting programme. BMC Health Serv Res. 2013;13:1–12.CrossRef

63.

Nystrand C, Helander M, Enebrink P, Feldman I, Sampaio F. Adding the coping power programme to parent management training: The cost-effectiveness of stacking interventions for children with disruptive behaviour disorders. ECAP. 2021;30:1603–14.

64.

Sampaio F, Barendregt JJ, Feldman I, Lee YY, Sawyer MG, et al. Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study. ECAP. 2018;27:933–44.

65.

Scavenius C, Amilon A, Schultz EA. A Cost-effectiveness analysis of caring in Chaos—a volunteer-delivered parent training program in Denmark. J Child Fam Stud. 2020;29:2836–49.CrossRef

66.

Charles JM, Edwards RT, Bywater T, Hutchings J. Micro-costing in public health economics: steps towards a standardized framework, using the incredible years toddler parenting program as a worked example. Prev Sci. 2013;14:377–89.PubMedCrossRef

67.

Iacobucci G. Cost of living is directly harming child health, paediatricians warn. BMJ. 2022;379:o2286. https://doi.org/10.1136/bmj.o2286.CrossRefPubMed

68.

Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C. Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. ECAP. 2022;31:879–89.

69.

Taylor-Robinson D, Barr B. Death rate now rising in UK’s poorest infants. BMJ. 2017;357:j2258. https://doi.org/10.1136/bmj.j2258.CrossRefPubMed

70.

Stalford H. The price is rights!: Cost benefit analysis and the resourcing of children’s services. Child Youth Serv Rev. 2019;99:395–407.CrossRef

71.

Suh E, Holmes L. A critical review of cost-effectiveness research in children’s social care: What have we learnt so far? Soc Pol Admin. 2022. https://doi.org/10.1111/spol.12795.CrossRef

72.

Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Mifflin and Company: Houghton; 2002.

73.

Fang Y, vanGrieken A, Fierloos IN, Windhorst DA, Jonkman H, et al. Parental, child and socio-contextual factors associated with parenting self-efficacy among parents of children aged 0–7 years old: the CIKEO study. Soc Psych Epid. 2022;57:623–32.CrossRef

74.

Cuijpers P. Universal prevention of depression at schools: dead end or challenging crossroad? BMJ Ment Health. 2022;25(3):96–8.

Title: A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme
Authors: Gráinne E. Crealey
Gráinne Hickey
Sinead McGilloway
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-023-10492-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2024

Evaluation of the nurse-assisted eHealth intervention ‘eHealth@Hospital-2-Home’ on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial

A mixed methods evaluation assessing the feasibility of implementing a PrEP data dashboard in the Southeastern United States

Examining nurses' understanding and knowledge about preparation for COVID-19 in Ardabil hospitals in Iran

Using the consolidated Framework for Implementation Research to integrate innovation recipients’ perspectives into the implementation of a digital version of the spinal cord injury health maintenance tool: a qualitative analysis

Management of pain in cancer patients— lessons from practices during the COVID-19: a qualitative study of cancer care providers’ perspectives

Drivers of vulnerability to medicine smuggling and combat strategies: a qualitative study based on online news media analysis in Iran