Background
Methods
Economic evaluation framework
Literature search
Intervention effect sizes
Parameters | Value and uncertainty range | Distribution used in PSA | Sources |
---|---|---|---|
Patient flowchart | |||
Proportion of parents offered the intervention | 60% (range 40–80) | Pert | Consultation with TAP |
Proportion of parents taking up the intervention | 60% (range 40–80) | Pert | NSMHWB [32] |
Proportion dropouts (completing 20% of intervention (2 sessions) | 42% (range 36–49) | Pert | |
Proportion of parents completing the intervention | 58% (range 52–65) | Pert | |
Epidemiological inputs | |||
Population | 5–9-year-old children with CD | 2013 Australian population [38] | |
All-cause mortality | Single age rates | 2013 Australian life tables [39] | |
Prevalence of conduct disorder | Average 5–18 age range 0.026 (see Supplementary Appendix for age- and sex-specific estimates) | Beta | [22] |
Remission | Average 5–18 age range 0.304 (see Supplementary Appendix for age- and sex-specific estimates) | Gamma | [22] |
Incidence | Average 5–18 age range 0,009 (see Supplementary Appendix for age- and sex-specific estimates) | Gamma | [22] |
Case fatality | 0b | [22] | |
Disability weight for conduct disorder | 0.241 (95% CI 0.159–0.341)c | Beta | [22] |
Effect size group Triple P | 0.054 (95% CI 0.003–0.875)d | Lognormal | [24] |
Effect size individual Triple P | 0.655 (95% CI 0.484–0.887)d | Lognormal | [25] |
Study population and intervention pathway
Modelling health benefits
Costing analysis
Cost parameters (AUS$) | Value and uncertainty range | Distribution used in PSAc | Sources |
---|---|---|---|
Cost of general practitioner (first visit) | Government: $97.27 | MBS items 2700, 2701, 2715 and 2717 [40] | |
Cost of general practitioner (follow-up visit) | Government: $70.30 | MBS item 2712 [40] | |
Cost of MBS-funded psychologist single | Government: $102.34; private: $18.06 | MBS items 80,010 and 80,110 [40] | |
Cost of MBS-funded psychologist group | Government: $25.61; private: $4.52 | MBS items 80,020 and 80,120 [40] | |
Cost workbooks Triple P | Triple P practitioner resourcesa | ||
Every parent | Private: $35 | ||
Every parent group workbook | Private: $14.95 | ||
Cost uncertainty parameter out-of-pocket costs | Range ± 20% of unit costs | Pert | Protocol |
Annual cost of a prevalent case of conduct disorder (for the calculation of cost offsets) | |||
Health care | 5–10 years: $1076.03 (both males and females) (range ± 20%) | Pert | Own calculations (see Section 5.2 of the Supplementary Appendix) |
11–18 years: males: $333.01; females: $141.03 (range ± 20%) | Pert | Own calculations (see Section 5.2 of the Supplementary Appendix) | |
Other sector costsb | 5–10 years: $2270.85 (both males and females) (range ± 20%) | Pert | Own calculations (see Section 5.2 of the Supplementary Appendix) |
11–18 years: males: $10,854.29; females: $1027.68 (range ± 20%) | Pert | Own calculations (see Section 5.2 of the Supplementary Appendix) | |
Time cost (per hour)b | $9.96 | (Uprated to 2013 AU$) [35] | |
Travel cost (per trip)b | $24.67 | (Uprated to 2013 AU$) [35] | |
Discount rate | 3% | [35] |
Uncertainty and sensitivity analyses
Results
Intervention delivery format | Mean ICER (95% UI) (AU$/DALY averted) | DALYs averted (95% UI) | Intervention costs (AU$) (95% UI) | Cost offsets (AU$) (95% UI) | Net costs (AU$) (95% UI) | ||
---|---|---|---|---|---|---|---|
Government | Private | Total | |||||
Group | 1013 (471–1956) | 2421 (1234–4116) | 4.6 M (3.3–6.1 M) | 912,862 (610,381–1.3 M) | 5.5 M (3.9–7.4 M) | 3.4 M (2 M–5 M) | 2.1 M (1.3–3.4 M) |
Individual | 20,498 (11,146–39,470) | 371 (161–670) | 6.3 M (4.4–8.4 M) | 859,465 (567,906–1.2 M) | 7.2 M (5–9.6 M) | 333,236 (163,830–554,751) | 6.8 M (4.8–9.2 M) |
Sensitivity analysis | Group ICER (95% UI) (AU$/DALY averted) | Individual ICER (95% UI) (AU$/DALY averted) |
---|---|---|
Base-case analysis | 1013 (471–1956) | 20,498 (11,146–39,470) |
(1) No cost offsets (health care) | 2460 (1542–3871) | 21,430 (11,828–40,682) |
(2) With cost offsets (health care + other sector costs) | Dominantc | 18,527 (9564–37,207) |
(3) With time and travel costs | 3567 (2233–5624) | 29,903 (16,532–56,903) |
(4a) 50% decay in effect size over 5 years | Dominantc (dominant to 2117)a | 13,911 (dominatedd to 77,650)b |
(4b) Full effect size extrapolated over 5 years | Dominantc | 2336 (1306–4009) |
(5) Dropouts get 50% of health benefit | 927 (477–1889) | 20,248 (10,756–38,509) |
(6a) Discount rate of 0% | 955 (439–1779) | 19,820 (10,610–38,218) |
(6b) Discount rate of 6% | 980 (494–2211) | 20,894 (11,295–41,068) |