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  • 1.
    Lenhard, Fabian
    et al.
    Uppsala Univ, Ctr Psychiat Res, Dept Clin Neurosci, Karolinska Inst,Dept Womens & Childrens Hlth,CHAP, Islandsgatan 2,Plan 3 Muninhuset, S-75185 Uppsala, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Ssegonja, Richard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Andersson, Erik
    Uppsala Univ, Ctr Psychiat Res, Dept Clin Neurosci, Karolinska Inst,Dept Womens & Childrens Hlth,CHAP, Islandsgatan 2,Plan 3 Muninhuset, S-75185 Uppsala, Sweden..
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Rück, Christian
    Uppsala Univ, Ctr Psychiat Res, Dept Clin Neurosci, Karolinska Inst,Dept Womens & Childrens Hlth,CHAP, Islandsgatan 2,Plan 3 Muninhuset, S-75185 Uppsala, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Mataix-Cols, David
    Uppsala Univ, Ctr Psychiat Res, Dept Clin Neurosci, Karolinska Inst,Dept Womens & Childrens Hlth,CHAP, Islandsgatan 2,Plan 3 Muninhuset, S-75185 Uppsala, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Serlachius, Eva
    Uppsala Univ, Ctr Psychiat Res, Dept Clin Neurosci, Karolinska Inst,Dept Womens & Childrens Hlth,CHAP, Islandsgatan 2,Plan 3 Muninhuset, S-75185 Uppsala, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Cost-effectiveness of Therapist-guided Internet-delivered Cognitive Behavior Therapy for Pediatric Obsessive-Compulsive Disorder2017Inngår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 20, nr S1, s. S21-S21Artikkel i tidsskrift (Annet vitenskapelig)
  • 2.
    Sampaio, Filipa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Enebrink, Pia
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Mihalopoulos, Cathrine
    Deakin Univ, Melbourne, Vic, Australia.
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems2016Inngår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 19, nr 4, s. 201-212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Parenting programs and self-help parenting interventions employing written materials are effective in reducing child conduct problems (CP) in the short-term compared to control groups, however evidence on the cost-effectiveness of such interventions is insufficient. Few studies have looked at the differences in effects between interventions in the same study design.

    AIM: This study aimed to determine the cost-effectiveness of four parenting programs: Comet, Incredible Years (IY), Cope and Connect, and bibliotherapy, compared to a waitlist control (WC), with a time horizon of 4 months, targeting CP in children aged 3-12 years.

    METHODS: This economic evaluation was conducted alongside an RCT of the four parenting interventions and bibliotherapy compared to a WC. The study sample consisted of 961 parents of 3-12 year-old children with CP. CP was measured by the Eyberg Child Behavior Inventory. Effectiveness was expressed as the proportion of "recovered" cases of CP. The time horizon of the study was four months with a limited health sector perspective, including parents' time costs. We performed an initial comparative cost analysis for interventions whose outcomes differed significantly from the WC, and later a cost-effectiveness analysis of interventions whose outcomes differed significantly from both the WC and each other. Secondary analyses were performed: (i) joint outcome "recovered and improved", (ii) intervention completers, (iii) exclusion of parents' time costs, (iv) exclusion of training costs.

    RESULTS: All interventions apart from Connect significantly reduced CP compared to the WC. Of the other interventions Comet resulted in a significantly higher proportion of recovered cases compared to bibliotherapy. A comparative cost analysis of the effective interventions rendered an average cost per recovered case for bibliotherapy of USD 483, Cope USD 1972, Comet USD 3741, and IY USD 6668. Furthermore, Comet had an ICER of USD 8375 compared to bibliotherapy. Secondary analyses of "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results.

    DISCUSSION: The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made.

    IMPLICATIONS FOR FUTURE RESEARCH: Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach.

    CONCLUSIONS: The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.

  • 3.
    Sampaio, Filipa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Enebrink, Pia
    Mihalopoulos, Cathy
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems: a multicentre randomized controlled trialInngår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176XArtikkel i tidsskrift (Fagfellevurdert)
  • 4.
    Sampaio, Filipa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Health Economic Evaluation of Four Parenting Programmes and a Book on Parent Management Techniques for Parents of Children with Conduct Problems: A Multicentre Randomised Controlled Trial2015Inngår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 18, nr S1, s. S34-S35Artikkel i tidsskrift (Annet vitenskapelig)
  • 5.
    Ssegonja, Richard
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Pihl, Charlotte
    Natl Board Hlth & Welf Socialstyrelsen, Stockholm, Sweden..
    Zethraeus, Niklas
    Karolinska Inst, Dept Learning Informat Management & Eth LIME, Stockholm, Sweden..
    Langenskiöld, Sophie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälsoekonomi.
    How Robust are Economic Evaluations of Parenting Programs for Managing Conduct Disorder?: A Systematic Literature Review2017Inngår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 20, nr S1, s. S31-S32Artikkel i tidsskrift (Annet vitenskapelig)
  • 6.
    Wellander, Lisa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Wells, Michael B.
    Karolinska Inst, Dept Publ Hlth Sci, Child & Adolescent Publ Hlth Epidemiol Grp, Stockholm, Sweden.;Stockholm Univ, Karolinska Inst, Ctr Hlth Equ Studies CHESS, Stockholm, Sweden..
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Does Prevention Pay?: Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems2016Inngår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 19, nr 2, s. 91-101Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial. AIMS OF THE STUDY: The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice. METHODS: This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required. RESULTS: The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation. DISCUSSION: Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices. IMPLICATIONS FOR HEALTH POLICIES: The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs. IMPLICATIONS FOR FUTURE RESEARCH: When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine implementation.

  • 7.
    Wellander, Lisa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Wells, Michael B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Does Prevention Pay?: Health and Economic Impact of Preventive Interventions for School Children Aimed to Improve Mental Health2015Inngår i: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 18, nr S1, s. S39-S40Artikkel i tidsskrift (Annet vitenskapelig)
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