Table 2:

Economic modelling analyses of parenting, early years and school-based interventions promoting mental health and well-being

Bibliographic information	Intervention (I), comparator (C) and study population	Sources of model parameters	Type of model and timeframe	Intervention cost	Perspective/price year	Economic results
		Study population	Economic analysis
(Aos et al., 2004), USA	I: Nurse–Family Partnership for low-income women: intensive visiting by nurses during pregnancy and the first 2 years after birth to promote child's development and provide instructive parenting skills to the parents	Systematic review and meta-analysis of evaluations of trials of preventive programmes conducted since 1970. Five trials identified	Decision analytical modelling	Cost of programme over 2.5 years: $9118	Societal	Total benefits $26 298. Net benefits $17 180. Benefit to cost ratio: 2.88 to 1 including primary recipient crime avoided: $14 476; secondary programme recipient: $1961;child abuse and neglect: $5686; alcohol: $541; illicit drugs: $309
	C: Screening for developmental problems at 2 years; free transportation to regular prenatal and well-child care local clinics	Cost of programme from Olds (2002)	To age 74		2003. USD
		Review of literature and statistics to estimate cost offsets of effective action	CBA
		Parents and children. Low income and at-risk pregnant women bearing their first child
(Aos et al., 2004), USA programmes	I: Home visiting programmes for at-risk. Mothers and children: including instruction in child development and health, referrals for service or social and emotional support	Systematic review and meta-analysis of evaluations of trials of preventive programmes conducted since 1970	Decision analytical modelling;	Costs: $4892	Societal	Benefits: $10 969. Net benefits: $6077 including child abuse and neglect avoided: $1126; alcohol: $107; illicit drugs (disordered use): $61
	C: Usual care	13 trials identified	To age 74	Synthesis of cost from a number of different home visiting projects	2003. USD
		Cost of programme from multiple papers in literature review	CBA
		Review of literature and statistics to estimate cost offsets of effective action
		Mothers considered to be at risk for parenting problems in terms of age, marital status and education, low income, mothers testing positive for drugs at the child's birth
(Aos et al., 2004), USA	I: Comprehensive school programme to reduce risk and bolster protective factors to prevent problem behaviours. Includes classroom, school and family involvement elements. Known as Caring School Community (CSC) or Child Development Project	Systematic review of evaluations of trials of preventive programmes conducted since 1970. One trial identified. Battistich et al. (1996)	Decision analytical modelling	Cost of programme per participant $16 over 2 years (based on personal communication with programme co-ordinator)	Societal	Costs: $16; benefits: $448
	C: No intervention	Programme costs from personal communication with programme co-ordinator	To age 74		2003. USD	Benefit to cost ratio: 28.42 to 1
			CBA			No mental health impacts included in benefits which covers drugs and alcohol only
(Aos et al., 2004), USA	I: ‘Behavioural Vaccine’ to encourage good behaviour at school. A ‘Good Behaviour Game’ is regularly played with prizes given to winning teams (who have better behaviour)	Systematic review of evaluations of trials of preventive programmes conducted since 1970. One trial identified. Kellam and Anthony (1998) focusing solely on tobacco	Decision analytical modelling	Costs: $8	Societal	Benefit to cost ratio: 25.92 to 1. But benefits only look at tobacco consumption avoided
	C: No intervention	Review of literature and statistics to estimate cost offsets of effective action	To age 74	Benefits: $204	2003 USD
		Hypothetical children in first 2 years of school	CBA
(Aos et al., 2004), USA	I: Seattle Social Development project: to train teachers to promote students ‘bonding to the school, to affect attitudes to school, behaviour in school, plus parent training'. Delivered for 6 years	Systematic review of evaluations of trials of preventive programmes conducted since 1970. One trial identified. Hawkins et al., (1999, 2005)	Decision analytical modelling	Costs: $4590	Societal	Benefits: $14 426
	C: No intervention	604 children from age 6 in high-crime urban areas in non-randomized controlled empirical study	To age 74		2003 USD	Benefit to cost ratio: 3.14 to 1.
			CBA			Benefits: crime: $3957; high school graduation: n: $10 320; K-12 grade repetition: $150
(Embry, 2002), USA	I: ‘Behavioural Vaccine’ to encourage good behaviour at school. A ‘Good Behaviour Game’ is regularly played with prizes given to winning teams (who have better behaviour)	Ad hoc review of literature on effectiveness. Additional data on budgetary impact from unrelated work in Wyoming	Decision analytical modelling	Implementation cost: $200 per child per year versus medication costs: $70 per child per month for children with behavioural problems	Health and education	If GBG cost $200 per child per year to implement for 5000 5 and 6 year olds, there would be potential costs averted of $15–20 million from a 5% reduction in special education placement, 2% reduction in involvement with corrections and 4% reduction in lifetime prevalence of tobacco use
	C: No intervention	Hypothetical 5000 5- and 6-year-old children at school in Wyoming	Lifetime		USD. Price year not stated
			COA
(Hummel et al., 2009), England	I: Whole school intervention to promote emotional and social well-being in secondary schools. Involves classroom intervention and peer mediation	Effectiveness data taken from paper identified through systematic review (Evers et al., 2007)	Decision analytical modelling	The estimated net total cost for a school with 600 pupils aged 11–16 is £9300 per year, or £15.50 per pupil per year	Education sector;	If intervention can reduce victimization by 15%, then cost per QALY gained of £9600. At a threshold of £20 000 it is 82% probable that the intervention is cost-effective, and at a threshold of £30 000, 92% probable
	C: No intervention	Hypothetical 600 school children aged 11–16	Lifetime	Classroom intervention: £7300; peer mediation: £3900; teacher time saved £1900	GBP. Price year not stated
			CUA
			COA
(Karoly et al., 1998, 2005), USA, Outcome data from Olds et al., (1997)	I: Home visiting programme; social support for mother until child is age 2	Data for high- and low-risk women taken from original outcome data of a Nurse–Family Partnership evaluation by Olds et al. (1997)	Decision analytical modelling	Cost of programme: $7271	Societal	Benefit to cost ratio:
	C: No intervention	Costing analysis builds on previous costings reported by Olds et al. (1993)	Lifetime	Monetary benefits to society include costs averted to public purse (including health and crime), additional income of mothers, reduction in victim costs of crime	2003 USD	High risk: 5.7 to 1 ($41 419: 7271)
		400 new mothers. Emphasis on teenage, single- and low-income mothers; but also other mothers	CBA			Low risk: 1.26 to 1 ($9151: $7271)
(McCabe, 2008), England	I: Universally delivered school-based PATH programme with three sessions per week of teacher led intervention; 10 weeks parent training	Systematic review of literature to identify (limited) effectiveness data	Decision analytical modelling	Cost per child per annum £125	Education sector	If positive impacts on emotional functioning only is £10 594 per QALY gained. Probability that cost per QALY is <£30 000 per QALY is 65%
	C: No intervention	Hypothetical cohort of children aged 7	3 years		2008 GBP	If the intervention impacts upon school performance (cognitive functioning) and emotional functioning, then £5500 per QALY. Prob QALY being <£30 000 is 66%
			CUA
(Mihalopoulos et al., 2007) and Turner et al. (2004), Australia	Triple P-Positive Parenting Programme, compared with no intervention	Systematic review that identified five RCTs on Triple P	Decision analytical modelling	The annual cost of implementing	‘Government as third part funder’ within health sector and criminal justice and education	Triple P has better outcomes and costs are outweighed by conduct disorder averted as long as prevalence of conduct disorder at least 7%
	Level 1: media and communication strategy targeting all parents	Children aged 2–12 years at risk of developing conduct disorders	To age 28	Triple P in Queensland to 572 701 children aged 2–12 years would be: AUD 19.7 million	2003 AUD	To pay for itself 1.5% of cases of conduct disorder would have to be averted per annum
	Level 2: 1–2 session intervention;		CEA	The cost for each level of intervention would be
	Level 3: more intensive but brief 4-session primary care intervention;		COA	Level 1: AUD 240 000
	Level 4: 8–10 session active skills training programme;			Level 2: AUD 5.8 million
	Level 5 targets parenting, partner skills, emotion coping skills and attribution retraining for the highest risk families			Level 3: AUD 5.7 million
				Level 4: AUD 4 million
				Level 5: AUD 3.6
				The average cost per child: AUD 34
				The cost of implementing Triple P to one cohort of 2 year olds would be AUD 9.6 million. The average cost per child in the cohort would be AUD 51

RCT, randomized controlled trial; CBA, cost–benefit analysis; CEA, cost-effectiveness analysis; CCA, cost-consequences analysis; CUA, cost–utility analysis; COA, cost-offset analysis.