Cost-Effectiveness of Digital Preventive Parent Training for Early Childhood Disruptive Behaviour.

Background: Childhood disruptive behaviour disorder associates with various, also costly problems. Parent training is effective in reducing childhood disruptive behaviour. Only a few studies have evaluated the cost-effectiveness of digital parent training in reducing children's disruptive behaviour.

Aims of the study: We evaluated the two-year cost-effectiveness of an Internet and telephone assisted parent training intervention called the Strongest Families Smart Website (SFSW) for prevention of children's disruptive behaviour compared to education control (EC) from the combined perspective of the health care funder and parents.

Methods: This study used data from a randomized controlled trial (RCT). The trial screened a population-based sample of 4,656 four-year-olds at annual child health clinic check-ups in Finnish primary care. A total of 464 disruptively behaving children participated in the RCT; half received the SFSW and half EC. We evaluated intention-to-treat based incremental net monetary benefit with a range of willingness to pay values. Costs contained the interventions' and parents' time-use costs. The effectiveness measure was the Child Behavior Checklist (CBCL/1.5-5) externalizing score. The trial is registered at Clinicaltrials.gov (NCT01750996).

Results: From the health care funder's perspective, SFSW costs per family were €1,982 and EC €661, and from the parents' perspective SFSW costs per family were €462 and EC €77. From the combined health care funder and parents' perspective, costs were €1,707 higher in the SFSW intervention than in EC. The SFSW decreased the CBCL externalizing score (1.94, SE=0.78, p=0.01) more in comparison to the EC group. In cost-effectiveness analysis using the combined perspective, the incremental net monetary benefit was zero [95% CI €-1,524 to €1,524] if the willingness to pay for one extra point of CBCL externalizing score reduced was €879. If the willingness to pay was more than €879, the average incremental net monetary benefit was positive.

Discussion: The cost-effectiveness of the SFSW depends on the decision makers' willingness to pay, which is not stated for CBCL outcomes. Also, the decision maker should consider the uncertainty of cost-effectiveness estimates. The lack of other service use information and micro-costing of SFSW and EC intervention costs weakens our conclusions. However, our study had multiple strengths, such as population-based screening, high sample size, 2-year follow-up, and use of proper methods to conduct a full economic evaluation.

Implications for health care provision and use: The SFSW is effective in reducing children's disruptive behaviour. Although digitally provided, the SFSW intervention included professional time and, thus, costs. The costs of intervention to the healthcare provider and time cost to families should be taken into account when interventions are implemented. The cost-effectiveness of SFSW interventions depends on the willingness to pay of health care decision makers.

Implications for health policies: Investment decisions should require high-quality economic evaluation of interventions and independent evaluation research of interventions should be financed.

Implications for further research: Decision makers need more economic evaluations of digital interventions. Research should use similar high-quality methods to allow comparison between studies. In an early planning phase of research, health economists should be consulted to enable usability of data and high-quality research.