4. Ron Prinz.pdf - Parenting and Family Support Centre

Health Economics of a Population Trial
Ron Prinz
Carolina Distinguished Professor
Director, Parenting and Family Research Center
University of South Carolina
(email: prinz@mailbox.sc.edu)
Symposium: Health Economic Studies of Triple P as a Population-
Based Approach (Chair: Norma Greenwood)
Helping Families Change Conference
Glasgow, Scotland February 2012

Economic advantages of a
population strategy
• Population strategy capitalizes on sources of
efficiency
– For example, media strategy reaches large numbers
– Materials and training taken to scale
• Small changes in prevalence rates translate into
large economic savings

Real example
• U.S. Triple P System Population Trial
• Health economist analyzed the cost of
implementation
• Washington State Institute for Public Policy
analyzed benefit to cost ratio

U.S. Triple P system popul. trial
• Place randomization design
• 18 counties
– Matched on size, poverty levels, and childmaltreatment
rates
– Randomized to Triple P system versus usual services
• Triple P disseminated in the 9 intervention
counties
– Levels 1 through 5
– Trained existing workforce in many settings and
agencies

U.S. Triple P system popul. trial
• Significant impact on main outcomes:
– Child out-of-home placements
– Child maltreatment injuries requiring hospital
treatment
– Child maltreatment cases

Sources of costs
• Training of workforce
• Program materials
• Consultation/support for trained staff
• Media strategy
• Estimated cost: $15 for every child age 0-12 in
the catchment area (population)

Population trial
• Implementation cost: $1.5 million
• Reduction in out-of-home placements alone
produced a cost offset of $3.76 million in one
year

Washington State Institute for
Public Policy
• Examined a broader array of benefits
• Able to use multiple databases to estimate
benefits and cost offsets

Benefit-cost analysis
Washington State Institute for Public Policy
directed by health economist Steve Aos
• Examined Triple P benefits and costs in the
context of the child welfare system
• Benefit to Cost Ratio
$9.22
• Comparable to other parent-based programs:
– Nurse Family Partnership $3.23
– Incredible Years $4.20

Conclusion
• Population-based dissemination of parenting
and family support interventions
– Have promising economic potential
– Can pay for themselves many times over
• Potential health-economics advantages of
population strategies
– Appear to be stronger than non-population
approaches
– Might even be greater when multiple goals (child
welfare, child mental health, school readiness) are
measured

References
Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based
prevention of child maltreatment: The U.S. triple P system population trial. Prevention Science,
10(1), 1-12.
Foster, E. M., Prinz, R. J., Sanders, M. R., & Shapiro, C. J. (2008). The costs of a public health
infrastructure for delivering parenting and family support. Children and Youth Services Review,
30(5), 493-501.
Prinz, R. (2009). Dissemination of a multilevel evidence-based system of parenting interventions with
broad application to child welfare populations. Child Welfare: Journal of Policy, Practice, and
Program, 88(1), 127-132.