Filipa Sampaio

A novel approach used outcome distribution curves to estimate the population-level impact of a public health intervention☆

OBJECTIVES To provide an analytical framework within which public health interventions can be evaluated, present its mathematical proof, and demonstrate its use using real trial data. STUDY DESIGN AND SETTING This article describes a method to assess population-level effects by describing change using the distribution curve. The area between the two overlapping distribution curves at baseline and follow-up represents the impact of the intervention, that is, the proportion of the target population that benefited from the intervention. RESULTS Using trial data from a parenting program, empirical proof of the idea is demonstrated on a measure of behavioral problems in 355 preschoolers using the Gaussian distribution curve. The intervention group had a 12% [9%-17%] health gain, whereas the control group had 3% [1%-7%]. In addition, for the subgroup of parents with lower education, the intervention produced a 15% [6%-25%] improvement, whereas for the group of parents with higher education the net health gain was 6% [4%-16%]. CONCLUSION It is possible to calculate the impact of public health interventions by using the distribution curve of a variable, which requires knowing the distribution function. The method can be used to assess the differential impact of population interventions and their potential to improve health inequities.

Are group-based parenting programmes in Sweden a cost-effective way of reducing early child behaviour problems?

Materials and methods A cost-effectiveness analysis of four programmes, Komet, Connect, the Incredible Years, Cope, and a selfguided book on parenting strategies compared to a waitlist control, was conducted at 4-months post-test, from a payer’s perspective, based on a RCT. The study samples consisted of 961 parents of 3-12 year-old children with conduct problems, including 862 who started a programme or reading a self-guided book, and 159 in the waitlist control. Conduct problems were measured by the Eyberg child behaviour inventory (ECBI). The outcome measures were the incremental cost per one point reduction in the ECBI intensity scale, and incremental cost per one averted clinical case of conduct problems.

Is the Salut Programme an effective and cost-effective universal health promotion intervention for parents and their children? A register-based retrospective observational study

Objectives This study investigates the effectiveness and cost-effectiveness of the Salut Programme, a universal health promotion intervention, compared with care-as-usual, over the periods of pregnancy, delivery and the child’s first 2 years of life. Method We adopted a register-based retrospective observational design using existing data sources with respect to both exposures and outcomes. Health outcomes and costs were compared between geographical areas that received care-as-usual (non-Salut area) and areas where the programme was implemented (Salut area). We included mothers and their children from both the Salut and non-Salut areas if: (1) the child was born 2002–2004 (premeasure period) or (2) the child was born 2006–2008 (postmeasure period). The effectiveness study adopted two strategies: (1) a matched difference-in-difference analysis using data from all participants and (2) a longitudinal analysis restricted to mothers who had given birth twice, that is, both in the premeasure and postmeasure periods. The economic evaluation was performed from a healthcare and a limited societal perspective. Outcomes were clustered during pregnancy, delivery and birth and the child’s first 2 years. Results Difference-in-difference analyses did not yield any significant effect on the outcomes. Longitudinal analyses resulted in significant positive improvement in Apgar scores, reflecting the newborn’s physical condition, with more children having a normal Apgar score (1 min +3%, 5 min +1%). The cost of the programme was international dollar (INT

Effectiveness and cost-effectiveness of the Salut Programme: a universal health promotion intervention for parents and children—protocol of a register-based retrospective observational study

)308/child. From both costing perspectives, the programme yielded higher effects and lower costs than care-as-usual, being thus cost-saving (probability of around 50%). Conclusions Our findings suggest that the Salut Programme is an effective universal intervention to improve maternal and child health, and it may be good value for money; however, there is large uncertainty around the cost estimates.

Cost and effects of a universal parenting programme delivered to parents of preschoolers

Introduction There is inadequate evidence for the effectiveness and cost-effectiveness of health promotion interventions. The Salut Programme aims to reach all parents and children in the Västerbotten County of Sweden with a combination of health promotion interventions initiated during pregnancy and continued over the childhood period. This study protocol describes an effectiveness study and an economic evaluation study, where the ongoing Salut Programme is compared to care-as-usual over the periods of pregnancy, delivery and the childs first 2 years of life. Methods A register-based retrospective observational study design will be used with existing data sources with respect to exposures and outcomes. Outcomes of interest are clustered at 3 points: around the childs birth, 1 month after the childs birth and 2 years after the childs birth. We will simulate an experiment by retrospectively identifying and comparing children and their parents in the geographical areas where the Salut Programme was implemented since 2006 and onwards, and the areas where the Programme was not implemented before 2009. Outcomes will be analysed and compared for the premeasure period, and the postmeasure period for both groups. Our analysis combines difference-in-difference estimation with matching. A complementary analysis will be carried out on the longitudinal subsample of mothers who gave birth at least once during each of the time periods. The economic evaluation aims to capture the wider societal costs and benefits of the Salut Programme for the first 2 years of the childrens lives. Incremental costs will be compared with incremental health gains and the results will be presented as a cost-consequence analysis. Ethics and dissemination The Regional Ethical Review Board in Umeå has given clearance for the Salut Programme research (2010-63-31M). No individuals identity will be revealed when presenting results. This study will provide information that can guide decision-makers to allocate resources optimally.

Quality of life and service use amongst parents of young children: Results from the Children and Parents in Focus trial

BACKGROUND Parenting programmes are effective in improving child behaviour and parental well-being, but long follow-up studies of universally offered programmes are scarce. METHODS A cluster randomized controlled trial was conducted to assess the costs and effects of Triple P levels 2-3 on child externalizing behaviours and parental mental health. The programme was offered universally to parents of preschoolers (self-selection allowed). Preschools were randomized to Triple P or a waitlist control. Health outcomes were reduction in externalizing behaviours measured on the Eyberg Child Behaviour Inventory-22 and improvement in parental mental health measured on the Depression Anxiety Stress Scales collected at baseline, 6-, 12- and 18-month follow-up. Child outcomes were based on 355 children aged 3-5 years (child sample) and parental outcomes on 759 parents (parental sample) with baseline data. Costs were collected from a municipality perspective, including 312 children and 488 parents with baseline data in the intervention preschools. RESULTS Sixty-seven (29%) parents attended the intervention. Triple P showed no significant improvement in child externalizing behaviours or parental mental health at either of the follow-up points. Triple P had an average yearly total cost of 3007 Swedish Krona (SEK) (€323) per child or 1922 SEK (€207) per parent. Running Triple P cost 227 SEK (€24) per child or 145 SEK (€16) per parent yearly. CONCLUSION Offering low intensity levels of Triple P with 29% attendance may not be a reasonable use of public resources, as no evidence of improvement in child externalizing behaviours or parental mental health was found.

Health, public sector service use and related costs of Swedish preschool children: results from the Children and Parents in Focus trial

Aim: The aim of this study was to assess the quality of life (QoL) and service use of parents who have preschool-aged children, and whether the mental-health problems of parents and their children predict these outcomes. Methods: Cross-sectional data were gathered in 2015–2016 in Uppsala County in Sweden where 3164 parents of children aged three- to five-years-old were asked to self-report their own and their children’s mental-health status and service use in the past 12 months. Data from the General Health Questionnaire were used to derive health-related quality of life (HRQoL) measures for adults. Results: Very few parents reported mental-health problems, while approximately 15% of the sample used any type of parental support and/or psychological health-care service. Families without problems used the least amount of resources. Parents’ own mental-health problems predicted usage of both psychotherapy and couples’ therapy, while child problems predicted the former but also the use of a parenting program. Parental HRQoL was predicted by mental-health problems, and all families with at least one individual experiencing problems rated their QoL lower than families without problems. Conclusions: Parental service use and HRQoL is associated not only with their own mental-health status but also with their children’s mental-health problems.

Response to Invited Commentary: Methods to address control for confounding and nonperfect randomization when using outcome distribution curves to estimate the population-level impact of a public health intervention

Despite Sweden’s good child health statistics, data on the mental health and wellbeing of Swedish preschool children is scarce and not routinely collected in healthcare. The study aimed to: identify the proportion of preschool children with mental health and somatic problems, the public sector services used by these children and whether they differ by type of problems, investigate whether other factors affect service use, and estimate the costs associated with these services. This study used cross-sectional data on a sample of 3175 children aged 3–5 from the “Children and Parents in Focus trial”. Data on service use, child health and demographics were obtained from primary caregivers. Child mental health was assessed by both primary caregivers and teachers. 8.9% of the sample reported mental health problems, and approximately 1% had comorbid somatic and mental health problems. Over 50% of the preschoolers used any service, with school assistant being the most frequently used. The average annual cost per child, regardless of health status, was US

Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems

921, with 75% of the costs accruing at school. The presence of both somatic and mental health problems predicted higher service use, in particular extra services used at school and at home (mean annual cost US

Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study

13826 and US