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Is Stacking Intervention Components Cost-Effective? An Analysis of the Incredible Years Program

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ABSTRACT

Objective

Research demonstrates that interventions targeting multiple settings within a child's life are more effective in treating or preventing conduct disorder. One such program is the Incredible Years Series, which comprises three treatment components, each focused on a different context and type of daily social interaction that a child encounters. This article explores the cost-effectiveness of stacking multiple intervention components versus delivering single intervention components.

Method

The data involved 459 children, ages 3 to 8, who participated in clinical trials of the Incredible Years Series. Children randomized to one of six treatment conditions received one or more of the three following program components: a child-based program, a parent training program, and a teacher-based program instructing teachers in classroom management and in the delivery of a classroom-based social skills curriculum.

Results

Per-child treatment costs and child behavior outcomes (observer and teacher reported) were used to generate cost-effectiveness acceptability curves; results suggest that stacking intervention components is likely cost-effective, at least for willingness to pay above $3,000 per child treated.

Conclusions

Economic data may be used to compare competing intervention formats. In the case of this program, providing multiple intervention components was cost-effective.

Section snippets

METHOD

The IY program, developed by one of the present authors (C.W.S.), and evaluated by colleagues at the University of Washington's Parenting Clinic, seeks to reduce delinquency, drug abuse, and violent behaviors among children with conduct problems. Treatment focuses on the reduction of conduct problems in children; the improvement of children's social, emotional, and academic abilities; the enhancement of parental competence; the encouragement of positive parenting techniques; and the promotion

RESULTS

The data provided in Table 1 indicate that children were not yet 6 years old at study entry. The vast majority of the children were white, and consistent with the population prevalence of CD, the majority of participants were male (American Psychological Association, 2000). The average maternal age was 36.5 years, suggesting that the youth comprising the sample may not represent first-born children.

Table 3 reports the change scores across waves for each treatment category as measured by the

DISCUSSION

This article examines the differential cost-effectiveness of delivering multiple treatment components in combination versus the delivery of a single component within the context of the Incredible Years program. A sophisticated (and appropriate) cost-effectiveness methodology-cost-effectiveness acceptability curves-was applied to the data.

Cost-effectiveness acceptability curves represent an important tool for comparing competing treatments or treatment formats. The degree of certainty is a

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    Disclosure: Dr. Webster-Stratton provides training and supplemental instructional materials for the programs described in this article, and therefore stands to gain financially. This interest has previously been disclosed to the University of Washington and is being managed consistent with federal and university policy. The other authors have no financial relationships to disclose.

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