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Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis
- Authors:
- EDWARDS Rhiannon T., et al
- Journal article citation:
- British Medical Journal, 31.03.07, 2007, pp.682-685.
- Publisher:
- British Medical Association
This study used an incremental cost effectiveness analysis alongside a pragmatic randomised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community. Sure Start areas in north and mid Wales were used in the study. Participants were parents of 116 children aged 36-59 months (87% of the clinical sample) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory). Children were identified by health visitors and recruited by the research team. The intervention used was the Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control. The main outcome measure used was incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory. The bootstrapped incremental cost effectiveness ratio point estimate was £73 per one point improvement on the intensity score (95% confidence interval £42 to £140). It would cost £5486 to bring the child with the highest intensity score to below the clinical cut-off point and £1344 to bring the average child in the intervention group within the non-clinical limits on the intensity score (below 127). For a ceiling ratio of £100 per point increase in intensity score, there is an 83.9% chance of the intervention being cost effective. The mean cost per child attending the parenting group was £1934 for eight children and £1289 for 12 children, including initial costs and materials for training group leaders. When the sample was categorised into relatively mild, moderate, and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder. It is concluded that this parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective compared with the waiting list control. This parenting programme involves modest costs and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending.
Living well for longer: the economic argument for investing in the health and wellbeing of older people in Wales
- Authors:
- EDWARDS Rhiannon Tudor, et al
- Publisher:
- Bangor University
- Publication year:
- 2018
- Pagination:
- 68
- Place of publication:
- London
This report, commissioned by Public Health Wales, explores the economic case for investing in older people in Wales to support people to live longer in good health in older age. It looks at investing in older people as assets, highlighting the importance of their contribution to the economy in Wales and the importance of housing and enabling independence in later life. It then draws on the results of rapid reviews of international and UK evidence to show the relative cost-effectiveness and return on investment on preventing loneliness and social isolation; caring for older carers; and preventing falls. It concludes that enabling people to work for longer, facilitating volunteering and supporting working parents through care of grandchildren brings many economic returns in terms of improving wellbeing; reducing loneliness, and supporting formal and wider community services. In addition co-production enables older people to remain active in the community and provides intergenerational benefits within the community and public sector services. The report concludes that Wales should focus investment on: fully integrated health and care services; maintaining physical and mental well being in older age, with a focus on reducing social isolation and loneliness; maintaining services to promote prevention (particularly falls prevention), rehabilitation and reablement; investment in sustainable homes, transport and communities; and support for informal carers. (Edited publisher abstract)
Incredible Years parenting programme: cost-effectiveness and implementation
- Authors:
- EDWARDS Rhiannon Tudor, et al
- Journal article citation:
- Journal of Children's Services, 11(1), 2016, pp.54-72.
- Publisher:
- Emerald
Purpose: There is growing interest in the economic evaluation of public health prevention initiatives and increasing government awareness of the societal costs of conduct disorder in early childhood. The purpose of this paper is to investigate the cost-effectiveness of the Incredible Years (IY) BASIC parenting programme compared with a six-month waiting list control. Design/methodology/approach: Cost-effectiveness analysis alongside a pragmatic randomised controlled trial of a group-parenting programme. The primary outcome measure was the Strengths and Difficulties Questionnaire (SDQ), a measure of child behaviour. Findings: The IY programme was found to have a high probability of being cost-effective, shifting an additional 23 per cent of children from above the clinical concern to below the cut-off on the SDQ compared to the control group, at a cost ranging from £1612-£2418 per child, depending on the number of children in the group. Originality/value: The positive findings of this study have led to ongoing implementation of the IY programme and is therefore an example of commitment to evidence-based service provision and investment in prevention initiatives. (Publisher abstract)
Dementia and imagination: a social return on investment analysis framework for art activities for people living with dementia
- Authors:
- JONES Carys, WINDLE Gill, EDWARDS Rhiannon Tudor
- Journal article citation:
- Gerontologist, 60(1), 2020, pp.112-123.
- Publisher:
- Oxford University Press
Background and Objectives: Arts activities may benefit people living with dementia. Social return on investment (SROI) analysis, a form of cost-benefit analysis, has the potential to capture the value of arts interventions, but few rigorous SROI analyses exist. This article presents a framework for an SROI analysis. Research Design and Methods: One hundred twenty-five people with mild to severe dementia and 146 caregivers were recruited to the Dementia and Imagination study across residential care homes, a hospital and community venues in England and Wales for a 12-week visual arts program. Quantitative and qualitative data on quality of life, support, and program perceptions were obtained through interviews. SROI was undertaken to explore the wider social value of the arts activities. Results: An input of £189,498 ($279,320/€257,338) to deliver the groups created a social value of £980,717 ($1,445,577/€1,331,814). This equates to a base case scenario of £/$/€5.18 of social value generated for every £/$/€1 invested. Sensitivity analysis produced a range from £/$/€3.20 to £/$/€6.62 per £/$/€1, depending on assumptions about benefit materialization; financial value of participants’ time; and length of sustained benefit. Discussion: To our knowledge, this is the first study applying SROI to an arts intervention for people with dementia. Arts-based activities appear to provide a positive SROI under a range of assumptions. Implications: Decision makers are increasingly seeking wider forms of economic evidence surrounding the costs and benefits of activities. This analysis is useful for service providers at all levels, from local government to care homes. (Publisher abstract)
A systematic review of the cost-effectiveness of interventions for supporting informal caregivers of people with dementia residing in the community
- Authors:
- JONES Carys, EDWARDS Rhiannon Tudor, HOUNSOME Barry;
- Journal article citation:
- International Psychogeriatrics, 24(1), January 2012, pp.6-18.
- Publisher:
- Cambridge Journals
The aim of this systematic review was to examine the evidence on health-related outcomes for caregivers following interventions targeting people with dementia and/or their caregivers. The evidence was limited to 12 intervention studies covering pharmacological, psychosocial, and service delivery interventions. The overall conclusion is that there is a lack of evidence on the cost-effectiveness of interventions to support caregivers, although some evidence of the beneficial effects on caregiver outcomes is reported.
A concise alternative for researching health-related quality of life in older people
- Authors:
- WINDLE Gillian, EDWARDS Rhiannon, BURHOLT Vanessa
- Journal article citation:
- Quality in Ageing, 5(3), November 2004, pp.13-24.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Examines a potentially shorter alternative to the sometimes lengthy and time-consuming health assessment tools used by researchers, the EQ-5D instrument. Data was obtained using trained interviewers from a randomly sampled cross-sectional survey of 423 community-dwelling older people aged 70-99. Information was obtained relating to activities of daily living, the EQ-5D, the EQ-VAS, the SF-36, use of health and social care services and the presence or absence of limiting illness, disability or infirmity. In terms of construct validity the EQ-5D was able to distinguish between hypothesised differences in the sample that could be expected to reflect differences in health-related quality of life. The EQ-5D items correlated well with conceptually similar items. Completion rates for the EQ-5D items were good, ranging from 98.3-98.8%. Completion rates for the EQ-VAS were 98.1%. Results suggest that the EQ-5D may provide a valid measure of health-related quality of life in a cross-sectional population sample of older adults, although the emphasis of the scale is very much on physical health and functioning. Results for the depression/anxiety item suggest that additional information may be needed if mental health is of concern.