Adding the Coping Power Programme to parent management training: the cost-effectiveness of stacking interventions for ch
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ORIGINAL CONTRIBUTION
Adding the Coping Power Programme to parent management training: the cost‑effectiveness of stacking interventions for children with disruptive behaviour disorders Camilla Nystrand1 · Maria Helander2 · Pia Enebrink2 · Inna Feldman1 · Filipa Sampaio1 Received: 27 March 2020 / Accepted: 1 September 2020 © The Author(s) 2020
Abstract Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8–12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015 Keywords Cost-effectiveness · Cognitive behavioural therapy · Parent management training · Child psychology
Introduction Oppositional defiant disorder (ODD) is a disruptive behaviour disorder, characterised by oppositional, argumentative behaviour, angry, irritable mood, or vindictiveness lasting for at least six months [1]. The prevalence of ODD is found to vary between 2 and 14% in epidemiologic samples and 28–50% in clinical samples [2]. ODD is further associated with secondary mood-, anxiety-, impulse control-, and substance use disorders [3]. Elevated ODD symptoms are, in * Camilla Nystrand [email protected] 1
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
2
addition, associated with higher levels of conduct problems over time and affected children face a higher probability of committing crimes [4]. ODD also constitutes a risk factor for the development into con
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