title: Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial from three economic perspectives.
abstract: The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at reducing risk factors and addressing the needs of COPMI-families in different domains. The intervention may lead to financial consequences in the healthcare sector and in other sectors, also known as inter-sectoral costs and benefits (ICBs). The objective of this study was to assess the cost-effectiveness of PBCM from three perspectives: a narrow healthcare perspective, a social care perspective (including childcare costs) and a broad societal perspective (including all ICBs).
  
  
  
  Effects on parenting quality (as measured by the HOME) and costs during an 18-month period were studied in in a randomized controlled trial. Families received PBCM (n = 49) or care as usual (CAU) (n = 50). For all three perspectives, incremental cost-effectiveness ratios (ICERs) were calculated. Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. Sensitivity analyses included calculating ICERs excluding cost outliers, and making an adjustment for baseline cost differences.
  
  
  
  Parenting quality improved in the PBCM group and declined in the CAU group, and PBCM was shown to be more costly than CAU. ICERs differ from 461 Euros (healthcare perspective) to 215 Euros (social care perspective) to 175 Euros (societal perspective) per one point improvement on the HOME T-score. The results of the sensitivity analyses, based on complete cases and excluding cost outliers, support the finding that the ICER is lower when adopting a broader perspective. The subgroup analysis and the analysis with baseline adjustments resulted in higher ICERs.
  
  
  
  This study is the first economic evaluation of family-focused preventive basic care management for COPMI in psychiatric and family services. The effects of the chosen perspective on determining the cost-effectiveness of PBCM underscore the importance of economic studies of interdepartmental policies. Future studies focusing on the cost-effectiveness of programs like PBCM in other sites and studies with more power are encouraged as this may improve the quality of information used in supporting decision making.
  
  
  
  NTR2569 , date of registration 2010-10-12.
authors.affiliation: Context, Prevention Department of the Parnassia Group, Lijnbaan 4, The Hague, 2512 VA, The Netherlands. h.wansink@indigohaaglanden.nl.
authors.forename: Henny J
authors.initials: HJ
authors.lastname: Wansink
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
authors.forename: Ruben M W A
authors.initials: RMWA
authors.lastname: Drost
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
authors.forename: Aggie T G
authors.initials: ATG
authors.lastname: Paulus
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ruwaard
authors.affiliation: Department of Clinical Psychology, Radboud University, Postbox 9104, Nijmegen, 6500 HE, The Netherlands.|Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Peter Debeyeplein 1, Maastricht, 6229 HA, The Netherlands.
authors.forename: Clemens M H
authors.initials: CMH
authors.lastname: Hosman
authors.affiliation: Department of Developmental Psychopathology, Radboud University, Postbox 9104, Nijmegen, 6500 HE, The Netherlands.
authors.forename: Jan M A M
authors.initials: JMAM
authors.lastname: Janssens
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.|Trimbos, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, Utrecht, 3521 VS, The Netherlands.
authors.forename: Silvia M A A
authors.initials: SMAA
authors.lastname: Evers
mesh_terms: D000293:Adolescent; D019090:Case Management / Q000191:economics*; D002648:Child; D000067576:Child Health; D016241:Child of Impaired Parents; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D016487:Parenting; D010290:Parents; D055815:Young Adult
keywords: Case management; Children of parents with a mental illness; Coordinated care; Cost-effectiveness analysis; Inter-sectoral costs and benefits; Mental health promotion; Prevention