Skip to main content

Advertisement

SpringerLink
Log in

A cost-effectiveness analysis of the Incredible Years parenting programme in reducing childhood health inequalities

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

Early onset of behavioural problems has lasting negative effects on a broad range of lifetime outcomes, placing large costs on individuals, families and society. A number of researchers and policy makers have argued that early interventions aimed at supporting the family is the most effective way of tackling child behaviour problems. This study forms the economic component of a randomised evaluation of the Incredible Years programme, a programme aimed at improving the skills and parenting strategies of parents of children with conduct problems. Our results show that the programme provides a cost-effective way of reducing behavioural problems. Furthermore, our cost analysis, when combined with a consideration of the potential long-run benefits, suggests that investment in such programmes may generate favourable long-run economic returns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. These relatively small sample sizes reflect the specific nature of the underlying population and are not unusual in studies of this nature (see for example Table 2.3 [37]. In addition, our findings show that the sample sizes we use are sufficient to precisely estimate the key parameters of our model.

  2. We are grateful to Fiachra Bane, CASEMIX/HIPE analyst at the HSE, for providing these figures. More information on the Irish Casemix system can be found at http://www.casemix.ie/.

  3. The estimate is based on a difference-in-difference approach that adjusts for differences in baseline values of the test score.

  4. Comparisons with the general population are difficult though the proportion of the total adult population in Ireland who had visited a GP at least once in the previous 12 months rose from 70.9% in 1987 to 85.6 in 2000 for medical card holders (typically low-income families) and from 52.9 to 66.9 for non-medical card holders [40]. And 16.7% of the adult population had an outpatient visit to a hospital during 2000. The comparative figures for inpatient and A&E visits were 12.9 and 11.8%, respectively [41].

  5. The estimated ICER using compliers only is slightly lower at €76. This reflects a smaller reduction in the ECBI score among the 7 families assigned to the IY intervention but who dropped out before completing the programme.

  6. For reviews of this and other cost-benefit studies, see [37, 43, 44].

  7. This is also close to the mid-point of the range of estimates reported by Koning et al. [10].

  8. Sometimes investments are summarised using net present values (NPV) rather than internal rate of returns. Assuming an opportunity cost of capital of 5%, the NPV of the IY program given our assumptions is €2,927 per child.

  9. Savings due to reduced crime constitute the largest component of many existing cost-benefit analyses of early childhood interventions [15, 47].

References

  1. National Institute for Health and Clinical Excellence: Parent-Training/Education Programmes in the Management of Children with Conduct Disorders, NICE Technology Appraisal guidance 102, London: NICE (2006)

  2. Collishaw, S., Maughan, B., Goodman, B.R., Pickles, A.: Time trends in adolescent mental health. J. Child Psychol. Psychiat. 45(8), 1350–1362 (2004)

    Article  PubMed  Google Scholar 

  3. Almond, D., Currie, J.: Human Capital Development Before the Age of Five. NBER Working Paper 15827 (2010)

  4. Gregg, P., Machin, S.: Childhood disadvantage and success or failure in the labour market. In: Blanchflower, D., Freeman, R. (eds.) Youth Employment and Joblessness in Advanced Countries. National Bureau of Economic Research, Cambridge, MA (1999)

    Google Scholar 

  5. Currie, J., Stabile, M.: Child mental health and human capital accumulation: the case of ADHD. J. Health Econ. 25(6), 1094–1118 (2006)

    Article  PubMed  Google Scholar 

  6. Currie, J., Stabile, M.: Mental health in childhood and human capital. In: Gruber, J. (ed.) The Problems of Disadvantaged Youth: An Economic Perspective, pp. 115–148. University of Chicago Press, NBER (2007)

    Google Scholar 

  7. Case, A., Fertig, A., Paxson, C.: The lasting impact of childhood health and circumstances. J. Health Econ. 24, 365–389 (2005)

    Article  PubMed  Google Scholar 

  8. Fletcher, J., Wolfe, B.: Child mental health and human capital accumulation: the case of ADHD revisited. J. Health Econ. 27, 794–800 (2008)

    Article  PubMed  Google Scholar 

  9. Ding, W., Lehrer, S., Niels, J., Rosenquist, Audrain-McGovern, J.: The impact of poor health on academic performance: new evidence using genetic markers. J. Health Econ. 28, 578–597 (2009)

    Article  PubMed  Google Scholar 

  10. Koning, P., Webbink, D., Vujic, S., Martin N.: The Effect of Childhood Conduct Disorder on Human Capital. IZA DP. No. 4940 (2010)

  11. Colman, I., Murray, J., Abbott, R., Maughan, B., Kuh, D., Croudace, T., Jones, P.: Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. British Med. J. 338a, 2981 (2009)

  12. Richards, M., Abbott, R.: Childhood Mental Health and Life Chances in Post-War Britain. Sainsbury Centre for Mental Health, London (2009)

    Google Scholar 

  13. Fergusson, D., Horwood, L., Ridder, E.: Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J. Child Psychol. Psychiat. 46(8), 837–849 (2005)

    Article  PubMed  Google Scholar 

  14. Sainsbury Centre for Mental Health: The Chance of a Lifetime: Preventing Early Conduct Problems and Reducing Crime. Policy paper (2009)

  15. Scott, S., Knapp, M., Henderson, J., Maughan, B.: Financial cost of social exclusion: follow-up study of antisocial children into adulthood. British Med. J. 323L, 1–5 (2001)

    Google Scholar 

  16. Cleary, A., Fitzgerald, M., Nixon, E.: From Child to Adult: A Longitudinal Study of Irish Children and their Families. Government of Ireland/Stat Office/Department of Social and Family Affairs, Dublin (2004)

  17. Caspi, A., Enter Wright, B., Moffitt, T., Silva, P.: Early failure in the labor market: childhood and adolescent predictors of unemployment in the transition to adulthood. Am. Sociol. Rev. 63(3), 424–451 (1998)

    Article  Google Scholar 

  18. Moffitt, T., Caspi, A., Harrington, H., Milne, B.: Males on life-course-persistent and adolescence-limited antisocial pathways: follow up at age 26 years. Dev. Psychopathol. 14, 179–207 (2002)

    Article  PubMed  Google Scholar 

  19. Odgers, C.L., Caspi, A., Broadbent, J., Dickson, N., Hancox, R., Harrington, H., Poulton, R., Sears, M., Thomson, W., Moffitt, T.: Prediction of differential adult health burden by conduct problem subtypes in males. Arch. Gen. Psychiat. 64, 476–484 (2007)

    Article  PubMed  Google Scholar 

  20. Wasserman, G., Keenan, K., Tremblay, R., Coie, J., Herrenkohl, T., Loeber, R.: Risk and Protective Factors of Child Delinquency. US Department of Justice, Washington DC (2003)

  21. Campbell, S.: Behaviour problems in pre-school children: a review of recent research. J. Child Psychol. Psychiat. 36, 113–149 (1995)

    Article  PubMed  CAS  Google Scholar 

  22. Dooley, M., Stewart, J.: Family income, parenting styles and child behavioural-emotional outcomes. Health Econ. 16, 145–162 (2007)

    Article  PubMed  Google Scholar 

  23. Brooks-Gunn, J., Markman, L.: The contribution of parenting to ethnic and racial gaps in school readiness. Future Child. 15(1), 139–168 (2005)

    Article  PubMed  Google Scholar 

  24. Bauer, N., Webster-Stratton, C.: Prevention of behavioural disorder in primary care. Curr. Opin. Pediatr. 18, 654–660 (2006)

    Article  PubMed  Google Scholar 

  25. Patterson, J., Barlow, J., Mockford, C., Klimes, I., Pyper, C., Stewart-Brown, S.: Improving mental health through parenting programmes: block randomised controlled trial. Arch. Dis. Child. 87, 472–477 (2002)

    Article  PubMed  CAS  Google Scholar 

  26. Gross, D., Fogg, L., Webster-Stratton, C., Garvey, C.W.J., Grady, J.: Parent training with multiethnic families of toddlers in day care in low-income urban communities. J. Consult. Clin. Psychol. 71, 261–278 (2003)

    Article  PubMed  Google Scholar 

  27. Hutchings, J., Bywater, T., Daley, D., Gardner, F., Whitaker, C., Jones, K., et al.: Parenting intervention in sure start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial. British Med. J. 334, 678–682 (2007)

    Article  Google Scholar 

  28. Fergusson, F., Stanley, L., Horwood, L.: Preliminary data on the efficacy of the incredible years basic parent programme in New Zealand. Aust. N. Z. J. Psychiat. 43(1), 76–79 (2009)

    Article  Google Scholar 

  29. Jones, J., Daley, D., Hutchings, J., Bywater, T., Eames, C.: Efficacy of the incredible years programme as an early intervention for children with conduct problems and ADHD: long-term follow-up. Child Care Health Dev. 34(3), 380–390 (2008)

    Article  PubMed  CAS  Google Scholar 

  30. Bywater, T., Hutchings, J., Daley, D., Whitaker, C., Tien Yeo, S., Jones, K., Eames, C., Tudor Edwards, R.: Long-term effectiveness of a parenting programme for children at risk of developing conduct disorder. British J. Psychiat. 195, 324–328 (2009)

    Google Scholar 

  31. Charles, J.M., Bywater, T., Edwards, R.T.: Parenting interventions: a systematic review of the economic evidence. Child Care Health Dev. (2011). Published online: 6 Mar 2011

  32. McGilloway, S., Bywater, T., Ni Mhaille, G., Comiskey, C., Leckey, Y., Kelly, P., Donnelly, M.: Preventing conduct problems through parenting programmes in disadvantaged areas: a pragmatic randomised controlled trial. In submission (2010)

  33. Eyberg, S.M., Ross, A.W.: Assessment of child behaviour problems: the validation of a new inventory. J. Clin. Child Psychol. Summer, 113–116 (1978)

  34. Lewit, E., Baker, L.: School readiness. Future Child. 5(2), 128–139 (1995)

    Article  PubMed  CAS  Google Scholar 

  35. Kiernan, G., Axford, N., Little, M., Murphy, C., Greene, S., Gormley, M.: The school readiness of children living in a disadvantaged area in Ireland. J. Early Child. Res. 6(2), 119–144 (2008)

    Article  Google Scholar 

  36. Little, R., Rubin, D.: Statistical Analysis with Missing Data. Wiley and Sons, New Jersey (2002)

    Google Scholar 

  37. Karoly, L., Kilburn, M., Cannon, J.: Early Childhood Interventions: Proven Results, Future Promises. RAND Corporation, Washington DC (2005)

    Google Scholar 

  38. Beecham, J., Knapp, M.: Costing psychiatric interventions. In: Thornicroft, G., Brewin, C., Wing, J. (eds.) Measuring Mental Health Needs, pp. 179–190. Gaskill, London (1992)

    Google Scholar 

  39. Edwards, R., O’Ceilleachair, A., Bywater, T., Hughes, D., Hutchings, J.: Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis. British Med. J. 334, 682–685 (2007)

    Google Scholar 

  40. Madden, D., Nolan, A., Nolan, B.: GP reimbursement and visiting behaviour in Ireland. Health Econ. 14, 1047–1060 (2005)

    Article  PubMed  Google Scholar 

  41. Harmon, C., Nolan, B.: Health insurance and health service utilizations in Ireland. Health Econ. 10, 135–145 (2001)

    Article  PubMed  CAS  Google Scholar 

  42. Aos, A., Lieb, R., Mayfield, J., Miller, M., Pennucci, P.: Benefits and Costs of Prevention and Early Intervention Programs for Youth. Olympia, Washington State Institute for Public Policy (2004). Available at http://www.wsipp.wa.gov/rptfiles/04-7-3901.pdf

  43. Dretzke, J.E., Frew, C., Davenport, J., Barlow, S., Stewart-Brown, J., Sandercock, S., Bayliss, J., Raftery,C., Hyde, R., Taylor: The Effectiveness and Cost-Effectiveness of Parent Training/Education Programmes for the Treatment of Conduct Disorder, Including Oppositional Defiant Disorder, in Children. West Midlands Health Technology Assessment Collaboration (WMHTAC), Department of Public Health and Epidemiology, The University of Birmingham (2004)

  44. Department for Children, Schools and Families: Cost-Benefit Analysis of Interventions with Parents. Research Report DCSF-RW0008 (2008)

  45. Friedli, L., Parsonage, M.: Mental Health Promotion: building an Economic Case. Northern Ireland association for Mental Health, Belfast (2007)

    Google Scholar 

  46. Irish Prison Service Annual Report 2007: Available online at http://www.irishprisons.i.e/documents/IPS_AR_2007.pdf

  47. Barnett, S.: Lives in the Balance: Age 27 Benefit Cost Analysis of the High/Scope Perry Preschool Program. High/Scope Educational Research Foundation Monograph No. 11, Ypsilanti, Michigan (1996)

  48. Hutchings, J., Lane, E., Kelly, J.: Comparison of two treatments for children with severely disruptive behaviours: a four-year follow-up. Behav. Cogn. Psychother. 32, 15–30 (2004)

    Article  Google Scholar 

  49. Webster-Stratton, C., Rinaldi, J., Reid, J.: Long-Term Outcomes of Incredible Years Parenting Program: Predictors of Adolescent Adjustment (2009). http://www.incredibleyears.com/library/items/long-term-outcomes-of-iy-parenting-pgrm_7-7-09.pdf

  50. McGilloway, S., Ni Mhaille, G., Furlong, M., Leckey, Y., Kelly, P., Bywater, T., Comiskey, C., Donnelly, M., O’Neill, D.: An Evaluation of the Longer-Term Effectiveness of the Incredible Years BASIC Parent Training Programme in Ireland: 12 Months Outcomes (2011)

  51. Barnett, S.: Benefits of compensatory preschool education. J. Human Resour. 27(2), 279–312 (1992)

    Article  Google Scholar 

  52. Heckman, J.R., LaLonde, Smith, J.: The economics and econometrics of active labour market programs. In: Ashenefelter, O., Card, D. (eds.) Handbook of Labour Economics (1999)

  53. OECD: Education at a Glance 2009: OECD Indicator (2009). Available online at http://www.oecd.org/dataoecd/35/35/43618388.pdf

Download references

Acknowledgments

We gratefully acknowledge the financial assistance provided by Archways Ltd, Ireland, with the support of the Atlantic Philanthropies. We would also like to thank Catherine Byrne, Mark Dynarski, Patricia Del Grosso, Paul Downes, Judy Hutchings, Olive Sweetman, Carolyn Webster-Stratton, members of the Incredible Years Ireland Study team and seminar participants at NUI Maynooth for their helpful comments on this work.

Author information

Authors and Affiliations

  1. Department of Economics, NUI Maynooth, Ireland and Research Fellow IZA, Bonn, Germany

    Donal O’Neill

  2. Department of Psychology, NUI Maynooth, Maynooth, Ireland

    Sinéad McGilloway & Paul Kelly

  3. Epidemiology and Services Research Group, School of Medicine, Queens University Belfast, Belfast, Northern Ireland, UK

    Michael Donnelly

  4. Institute for Effective Education, University of York, York, UK

    Tracey Bywater

  5. Bangor University, Wales, UK

    Tracey Bywater

Authors
  1. Donal O’Neill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sinéad McGilloway
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Donnelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tracey Bywater
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donal O’Neill.

Rights and permissions

Reprints and permissions

About this article

Cite this article

O’Neill, D., McGilloway, S., Donnelly, M. et al. A cost-effectiveness analysis of the Incredible Years parenting programme in reducing childhood health inequalities. Eur J Health Econ 14, 85–94 (2013). https://doi.org/10.1007/s10198-011-0342-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-011-0342-y

Keywords

JEL Classification

Search

Navigation