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Joanna Charles Supervised by Prof. Rhiannon Tudor Edwards and Dr. Tracey Bywater
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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.
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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
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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).
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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.
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Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Intervention (N=53) Control (N=25) Intervention (N=38) Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care3.4£123.112.2£66.321.8£55.662.3£71.00 Social services0.2£7.620.04£1.240.1£36.880£0.00 Hospital Services1.0£207.500.6£114.080.5£99.050.2£34.30 Total4.6£338.232.84£181.642.4£191.592.5£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
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Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Intervention (N=53) Control (N=25) Intervention (N=38) Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care3.4£123.112.2£66.321.8£55.662.3£71.00 Social services0.2£7.620.04£1.240.1£36.880£0.00 Hospital Services1.0£207.500.6£114.080.5£99.050.2£34.30 Total4.6£338.232.84£181.642.4£191.592.5£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
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Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Intervention (N=53) Control (N=25) Intervention (N=38) Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care3.4£123.112.2£66.321.8£55.662.3£71.00 Social services0.2£7.620.04£1.240.1£36.880£0.00 Hospital Services1.0£207.500.6£114.080.5£99.050.2£34.30 Total4.6£338.232.84£181.642.4£191.592.5£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
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Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Intervention (N=53) Control (N=25) Intervention (N=38) Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care3.4£123.112.2£66.321.8£55.662.3£71.00 Social services0.2£7.620.04£1.240.1£36.880£0.00 Hospital Services1.0£207.500.6£114.080.5£99.050.2£34.30 Total4.6£338.232.84£181.642.4£191.592.5£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
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Time point 1 (6 months post-baseline) Time point 2 (12 months post-baseline) Intervention (N=53) Control (N=25) Intervention (N=38) Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care3.4£123.112.2£66.321.8£55.662.3£71.00 Social services0.2£7.620.04£1.240.1£36.880£0.00 Hospital Services1.0£207.500.6£114.080.5£99.050.2£34.30 Total4.6£338.232.84£181.642.4£191.592.5£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
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Time point 1 (6 months post-baseline)Time point 2 (12 months post-baseline) Intervention (N=53)Control (N=25)Intervention (N=38)Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care4.3£187.752.9£104.042.6£109.583.3£119.80 Social services5.3£28.920.2£43.880.2£17.820.2£22.50 Hospital Services0.7£107.080.4£57.800.6£86.890.3£186.70 Total10.3£323.753.5£205.723.4£214.293.8£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
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Time point 1 (6 months post-baseline)Time point 2 (12 months post-baseline) Intervention (N=53)Control (N=25)Intervention (N=38)Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care4.3£187.752.9£104.042.6£109.583.3£119.80 Social services5.3£28.920.2£43.880.2£17.820.2£22.50 Hospital Services0.7£107.080.4£57.800.6£86.890.3£186.70 Total10.3£323.753.5£205.723.4£214.293.8£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
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Time point 1 (6 months post-baseline)Time point 2 (12 months post-baseline) Intervention (N=53)Control (N=25)Intervention (N=38)Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care4.3£187.752.9£104.042.6£109.583.3£119.80 Social services5.3£28.920.2£43.880.2£17.820.2£22.50 Hospital Services0.7£107.080.4£57.800.6£86.890.3£186.70 Total10.3£323.753.5£205.723.4£214.293.8£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
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Time point 1 (6 months post-baseline)Time point 2 (12 months post-baseline) Intervention (N=53)Control (N=25)Intervention (N=38)Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care4.3£187.752.9£104.042.6£109.583.3£119.80 Social services5.3£28.920.2£43.880.2£17.820.2£22.50 Hospital Services0.7£107.080.4£57.800.6£86.890.3£186.70 Total10.3£323.753.5£205.723.4£214.293.8£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
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Time point 1 (6 months post-baseline)Time point 2 (12 months post-baseline) Intervention (N=53)Control (N=25)Intervention (N=38)Control (N=10) Type of serviceMean Frequency Mean Cost Mean Frequency Mean Cost Mean Frequency Mean CostMean Frequency Mean Cost Primary care4.3£187.752.9£104.042.6£109.583.3£119.80 Social services5.3£28.920.2£43.880.2£17.820.2£22.50 Hospital Services0.7£107.080.4£57.800.6£86.890.3£186.70 Total10.3£323.753.5£205.723.4£214.293.8£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
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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.
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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).
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