The ICER is a ratio comparing the additional costs and effects in the experimental intervention with the control intervention. ICERs were calculated using the formula: In this study, C represents the average total costs per family during the whole follow-up period of eighteen months, and E represents the mean difference between the HOME score at T2 and the HOME score at T0 in the PBCM condition (subscript i) and control condition (subscript c). Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. By using the bootstrapping technique in Excel, the original sample was re-sampled, which resulted in 5000 simulated ICERs per scenario. These were plotted in cost-effectiveness planes (Fig. 2a,b,c). These planes provide a visual representation on the probability of PBCM being cost-effective in comparison with the control condition (the 0,0 coordinate) by showing the distribution of simulated ICERs across four quadrants: 1) the Northeast (NE) quadrant, which means that the intervention is more effective and more costly than CAU, 2) the Southeast (SE) quadrant, indicating that the intervention is more effective and less costly, 3) the Southwest (SW) quadrant, indicating that the intervention is less effective and less costly and 4) the Northwest (NW) quadrant, indicating that the intervention is less effective and more costly. An ICER in the SE and NW quadrant is negative, which represents the situation in which the intervention is either clearly dominant over (SE) or inferior to (NW) CAU. An ICER in the SW or NE quadrant is positive, which means, from a cost-effectiveness perspective, that the intervention is more favorable than the control condition only when the ICER is lower than the maximum willingness to pay (WTP max) per unit effect. The WTP max is the maximum expense a society is willing to pay for better outcomes (parenting quality, in this study). Since no acknowledged threshold, i.e. WTP max, is available for the HOME outcome measure, a CEAC was created for each perspective (Fig. 2d,e,f). The CEAC shows the likelihood of PBCM being favorable over the control intervention for several different hypothetical maximum WTPs. |