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Balancing costs and effects based on a randomised comparison of Parent...

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Title Balancing costs and effects based on a randomised comparison of Parent Management Training Oregon and Care As Usual in children with severe conduct disorders
Period 06 / 2008 - 12 / 2013
Status Current
Research number OND1334441
Data Supplier ZonMw Projectenpoort

Abstract

The aim of this project is first to evaluate the balance between costs and effects of Parent Management Training Oregon (PMTO) as compared to Care-As-Usual (CAU) in primary school children with serious behavioural problems, and second to develop a framework for economic evaluation in child and youth care. Several research questions arise from this aim.1 What are the effects of PMTO as compared to CAU at the level of the child (behaviour problems at home and at school, school performance, contact with police), the parents (parenting stress, psychological problems, parenting skills and parent satisfaction), and the family (videotaped parent-child interaction and contacts with child protection agency)?2 What are the overall costs incurred by and after PMTO as compared to CAU?3 How do different stakeholders, i.e. parents, family members, professionals and lay public value antisocial behaviour as compared to normal behaviour using direct rating scales, Time Trade Off (TTO) methods and possibly others?4 How do the outcomes of the above research questions 1 and 3 correlate with health related quality of life outcomes generally used in health economics, i.e. the Child Health Questionnaire and EQ5D?5 What is the incremental cost-effectiveness of MST as compared to CAU in children with antisocial behaviour, in terms of costs per outcome mentioned under 1 (behaviour problems avoided, delinquent act avoided, school drop out avoided, parental stress and problems decreased and skills and satisfaction increased, and abusive interactions avoided), and per QALY gained. In sum, what is the cost-effectiveness of PMTO compared to CAU?6 Can a common framework for economic evaluations in youth care be developed?
BACKGROUND The treatment of children with severe conduct disorders is a challenge for practitioners and academics. Parent Management Training Oregon (PMTO) is promising as such. In the USA, it has been shown to be effective in the treatment of children with serious forms of antisocial behavioural patterns . A study of De Ruiter and co-workers is expected to deliver substantial new evidence. It concerns a randomized controlled trial that compares PMTO to Care As Usual in the Dutch setting. This study as yet does not comprise a full economic evaluation. Knowledge on the cost-effectiveness of PMTO and other treatments for severe conduct disorders is lacking. In general, such economic evaluations of child and youth care can be expected to differ from those conducted in healthcare in several aspects, e.g. valuation of outcomes, accounting for participation in paid labour and societal costs of services use and delinquent behaviour. Thus the standard methodology for the assessment of costs and of outcomes and for the valuation of outcomes may need to be adapted to the specific setting.AIM The aim of this project is first to evaluate the balance between costs and effects of PMTO as compared to Care-As-Usual (CAU) in children with severe conduct disorders and behavioural problems, and second to outline a broad framework for economic evaluation in child and youth care.WORKING PLAN To reach these aims, we propose a study of costs and effects of PMTO framed within the already planned study of De Ruiter and co-workers on the effects of PMTO in the Netherlands. We will add to the fieldwork of that study:-an assessment of costs incurred for PMTO and CAU provided to the control group-an assessment of additional outcomes (effects) such as quality of life experienced (Child Health Questionnaire and EQ5D) not currently included in De Ruiter s study, but standard practice in the assessment of cost-effectiveness in health care (i.e. health economics)-an estimate of effects to be expected after the intervention period, based on a synthesis of the available evidence regarding long-term effects. Moreover, we propose to perform a more general evaluation among relevant stakeholder groups of the utility of several outcomes that are considered relevant in the realm of severe antisocial behaviour. Regarding costs, actual costs of the interventions as well as associated costs will be determined. This will comprise the (time) costs of the professionals, inclusive of training, overhead, communication with relevant stakeholders, and time and travel costs of other relevant stakeholders (family members, educational system etc.) directly involved in planning and coaching of the children with severe conduct disorders.Effects to be assessed will primarily concern the primary outcomes as defined by De Ruiter and co-workers, i.e. outcomes concerning the child (behaviour problems at home and at school, school performance, contact with police), concerning the parents (parenting stress, psychological problems, parenting skills and parent satisfaction), and concerning the family (videotaped parent-child interaction and contacts with child protection agency). These outcomes in theory enable the performance of cost-effectiveness analyses, in which incremental costs are balanced against events averted for a number of different outcomes. Regarding the impact of the condition and successive treatments, we will explore specific domains of (health related) quality of life. We intend to approach several groups of stakeholders, i.e. parents, professionals from the care sector and the judicial sector to develop scales, and measure and establish a valuation or utility score for typical antisocial behaviour. Collaboration with other groups granted financial support for evaluation of specific interventions in this field and freeing or obtaining additional resources for the latter might be a viable option. Direct rating scales, Time Trade Off (TTO) procedures (i.e. which proportion of a given lifetime is an individual willing to trade off if quality of life improves to a defined degree) and Willingness To Pay (WTP) procedure (idem, but now in monetary terms), will be used to valuate the outcomes of interest The project will be performed in close co-operation with other research groups working on the economic evaluation of child and youth care under the umbrella of the same ZonMw program. We foresee that the latter part can only be performed on the basis of such a co-operation.EXPECTED RESULTS The expertise of the research group covers a broad range, from child and youth care, and ortho-pedagogy, to preventive child health care, and mental health, epidemiology, medical technology assessment and economic evaluation. We expect this project to yield important new knowledge that can be applied in these fields. Also the results will contribute to the scientific knowledge needed for care and decision making in child and youth care.

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Project leader Prof.dr. S.A. Reijneveld

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