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Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis

BMJ 2007; 334 doi: (Published 29 March 2007) Cite this as: BMJ 2007;334:682
  1. Rhiannon T Edwards, senior research fellow in health economics1,
  2. Alan Céilleachair, research officer in health economics1,
  3. Tracey Bywater, project trial coordinator2,
  4. Dyfrig A Hughes, senior research fellow in pharmacoeconomics1,
  5. Judy Hutchings, research director2
  1. 1Centre for the Economics and Policy in Health, Institute of Medical and Social Care Research (IMSCaR), University of Wales Bangor, Bangor LL57 1UT
  2. 2School of Psychology, University of Wales Bangor
  1. Correspondence to: R T Edwards r.t.edwards{at}
  • Accepted 23 January 2007


Objective To investigate the cost effectiveness of a parenting programme.

Design An incremental cost effectiveness analysis alongside a pragmatic randomised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community.

Setting Sure Start areas in north and mid Wales.

Participants Parents of 116 children aged 36-59 months (87% of the clinical sample) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory). Children were identified by health visitors and recruited by the research team.

Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control.

Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory.

Results The bootstrapped incremental cost effectiveness ratio point estimate was £73 (€109, $142) per one point improvement on the intensity score (95% confidence interval £42 to £140). It would cost £5486 (€8190, $10 666) to bring the child with the highest intensity score to below the clinical cut-off point and £1344 (€2006, $2618) to bring the average child in the intervention group within the non-clinical limits on the intensity score (below 127). For a ceiling ratio of £100 (€149, $194) per point increase in intensity score, there is an 83.9% chance of the intervention being cost effective. The mean cost per child attending the parenting group was £1934 (€2887, $3760) for eight children and £1289 (€1924, $2506) for 12 children, including initial costs and materials for training group leaders. When we categorised the sample into relatively mild, moderate, and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder.

Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective compared with the waiting list control. This parenting programme involves modest costs and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending.


  • We thank the extended Incredible Years Wales team, particularly Pam Dewis, Karen Jones, Catrin Eames, Dilys Williams, Pam Martin, Bridget Large, Nicola Armstrong, Claire Davis, Cara Rogowski, and Michelle O'Brien. We also thank all participating families, Sure Start staff, and group leaders; Ian Russell for his efforts in guiding the authors with respect to the submission process; and Daphne Russell and Chris Whitaker for their statistical support.

  • Contributors: RTE was principal investigator on the economic evaluation and contributed to design, implementation, management of the economic evaluation, analysis and interpretation of data, and writing the paper. AÓC was the lead health economics researcher and was responsible for designing and implementing the data management plan and entering, verifying, analysing, and validating data. He contributed to implementing the trial design, analysing and interpreting data, and writing the paper. TB managed the clinical project, conducted randomisation, collected and coded data, and redrafted the paper. DAH confirmed the final findings and assisted in the presentation and wording of the final draft. JH was primary investigator on the main clinical trial funded by the Health Foundation. She was a co-applicant on the bolt-on economic evaluation grant proposal and helped to redraft the paper. RTE is guarantor.

  • Funding: Research grant from the Health Foundation, grant No 1583/2594.

  • Competing interests: JH is paid by Incredible Years for running occasional training courses in the delivery of the parent programme and has served as an expert witness for the NICE appraisal on parenting and conduct disorder.

  • Ethical approval: North West Wales research ethics committee.

  • Accepted 23 January 2007
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