The online version of this article (https://doi.org/10.1007/s11121-018-0893-6) contains supplementary material, which is available to authorized users.
Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the “value for money.” The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to “status quo” (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts.
ESM 1 (DOCX 27 kb)11121_2018_893_MOESM1_ESM.docx
Beckman, L., & Svensson, M. (2015). The cost-effectiveness of the Olweus bullying prevention program: Results from a modelling study. Journal of Adolescence, 45, 127–137. https://doi.org/10.1016/j.adolescence.2015.07.020. CrossRefPubMed
Briggs, A., Sculpher, M., & Claxton, K. (2006). Decision modelling for health economic evaluation. Oxford: OUP.
Briggs, A., Weinstein, M. C., Fenwick, E. A., Karnon, J., Sculpher, M. J., & Paltiel, A. D. (2012). Model parameter estimation and uncertainty analysis a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group–6. Medical Decision Making, 32(5), 722–732. https://doi.org/10.1177/0272989X12458348. CrossRefPubMed
Chester, K. L., Callaghan, M., Cosma, A., Donnelly, P., Craig, W., Walsh, S., & Molcho, M. (2015). Cross-national time trends in bullying victimization in 33 countries among children aged 11, 13 and 15 from 2002 to 2010. The European Journal of Public Health, 25(suppl 2), 61–64. https://doi.org/10.1093/eurpub/ckv029. CrossRefPubMed
Currie, C., Zanotti, C., Morgan, A., Currie, D., de Looze, M., & Roberts, C., Samdal, O., Smith, O., & Barnekow, V. (2012). Social determinants of health 28 and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: International report from the 2009/10 survey. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf. Accessed 10 Oct 2016.
Eriksen, T. L. M., Nielsen, H. S., & Simonsen, M. (2014). Bullying in elementary school. Journal of Human Resources, 49(4), 839–871. CrossRef
Evans, C. B. R., Fraser, M. W., & Cotter, K. L. (2014). The effectiveness of school-based bullying prevention programs: A systematic review. Aggression and Violent Behavior, 19(5), 532–544. https://doi.org/10.1016/j.avb.2014.07.004. CrossRef
Garandeau, C. F., Lee, I. A., & Salmivalli, C. (2014). Differential effects of the KiVa anti-bullying program on popular and unpopular bullies. Journal of Applied Developmental Psychology, 35(1), 44–50. CrossRef
Kärnä, A., Voeten, M., Little, T., Poskiparta, E., Kaljonen, A., & Salmivalli, C. (2011b). A large-scale evaluation of the KiVa antibullying program: Grades 4–6. Child Development, 82(1), 311–330. https://doi.org/10.1111/j.1467-8624.2010.01557.x. CrossRefPubMed
Olweus, D. (1993). Bullying at school: What we know and what we can do. Oxford: Blackwell.
Persson, M., & Svensson, M. (2013). The willingness to pay to reduce school bullying. Economics of Education Review, 35, 1–11. https://doi.org/10.1016/j.econedurev.2013.02.004. CrossRef
Salmivalli, C., Lagerspetz, K., Björkqvist, K., Österman, K., & Kaukiainen, A. (1998). Bullying as a group process: Participant roles and their relations to social status within the group. Aggressive Behavior, 22(1), 1–15. https://doi.org/10.1002/(SICI)1098-2337(1996)22:1<1::AID-AB1>3.0.CO;2-T. CrossRef
Salmivalli, C., Kärnä, A., & Poskiparta, E. (2011). Counteracting bullying in Finland: The KiVa program and its effects on different forms of being bullied. International Journal of Behavioral Development, 35(5), 405–411. CrossRef
Salmivalli, C., Boulton, A. J., Poskiparta, E. H., Haataja, A., Voeten, M. J. M., & Ahtola, A. (2014). The KiVa antibullying curriculum and outcome: Does fidelity matter? Journal of School Psychology, 52(5), 479–493. https://doi.org/10.1016/j.jsp.2014.07.001. CrossRefPubMed
Siegel, J. E., Weinstein, M. C., Russell, L. B., & Gold, M. R. (1996). Recommendations for reporting cost-effectiveness analyses. JAMA, 276(16), 1339–1341. https://doi.org/10.1001/jama.1996.03540160061034. CrossRefPubMed
Sigurdson, J. F., Undheim, A. M., Wallander, J. L., Lydersen, S., & Sund, A. M. (2015). The long-term effects of being bullied or a bully in adolescence on externalizing and internalizing mental health problems in adulthood. Child and Adolescent Psychiatry and Mental Health, 9(1), 1. CrossRef
Smokowski, P. R., Evans, C. B. R., & Cotter, K. L. (2014). The differential impact of episodic, chronic, and cumulative physical bullying and cyberbullying: The effects of victimization on the school experiences, social support, and mental health of rural adolescents. Violence and Victims, 29(6), 1029–1046. https://doi.org/10.1891/0886-6708.VV-D-13-00076. CrossRefPubMed
Statistics Sweden. (2014). Average salary for teachers in elementary school. Retrieved from https://www.scb.se/sv_/Hitta-statistik/Temaomraden/Jamstalldhet/Fordjupningar/Utbildning-och-forskning/Larare-och-skolledare/Genomsnittlig-lon-for-larare-i-grundskolan/#. Accessed 10 Oct 2016.
Swedish National Agency for Education. (2006). Curriculum for the compulsory school system, the pre-school class and the leisure-time centre Lpo 94. Retrieved from https://www.skolverket.se/regelverk/skolfs/skolfs?_xurl_=http%3A%2F%2Fwww5.skolverket.se%2Fwtpub%2Fws%2Fskolfs%2Fwpubext%2Ffs%2FRecord%3Fk%3D258. Accessed 11 Oct 2016.
Swedish National Agency for Education. (2015). Schools and students compulsory school academic year 2015/16. Retrieved from https://www.skolverket.se/statistik-och-utvardering/statistik-i-tabeller/grundskola/skolor-och-elever. Accessed 10 Oct 2016.
Takizawa, R., Maughan, B., & Arseneault, L. (2014). Adult health outcomes of childhood bullying victimization: Evidence from a five-decade longitudinal British birth cohort. American Journal of Psychiatry.https://doi.org/10.1176/appi.ajp.2014.13101401.
The National Board of Health and Welfare. (2011). Nationella riktlinjer för sjukdomsförebyggande metoder 2011—Hälsoekonomiskt underlag. Retrieved from http://www.socialstyrelsen.se/nationellariktlinjerforsjukdomsforebyggandemetoder/Documents/nr-sjukdomsforebyggande-halsoekonomisktunderlag.pdf. Accessed 11 Oct 2016.
TLV. (2003). Läkemedelsförmånsnämndens allmänna råd om ekonomiska utvärderingar. Retrieved from https://www.tlv.se/download/18.467926b615d084471ac3396a/1510316400272/LAG-lfnar-2003-2.pdf. Accessed 10 Oct 2016.
Wolke, D., & Lereya, S. T. (2015). Long-term effects of bullying. BMJ. https://doi.org/10.1136/archdischild-2015-309491.
Yang, A., & Salmivalli, C. (2013). Different forms of bullying and victimization: Bully-victims versus bullies and victims. European Journal of Developmental Psychology, 10(6), 723–738. https://doi.org/10.1080/17405629.2013.793596. CrossRef
- The Cost-Effectiveness of the Kiva Antibullying Program: Results from a Decision-Analytic Model
- Springer US