Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial from three economic perspectivesReport as inadecuate

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BMC Health Services Research

, 16:228

Utilization, expenditure, economics and financing systems


BackgroundThe 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.

MethodsEffects 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.

ResultsParenting 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.

ConclusionsThis 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 registrationNTR2569, date of registration 2010-10-12.

KeywordsCase management Coordinated care Prevention Inter-sectoral costs and benefits Cost-effectiveness analysis Children of parents with a mental illness Mental health promotion Electronic supplementary materialThe online version of this article doi:10.1186-s12913-016-1498-z contains supplementary material, which is available to authorized users.

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