Cost-Effectiveness of screening and intervention for social-emotional problems in preschoolers

Abstract Background Poor social-emotional functioning in childhood is a risk factor that has been linked with mental health problems later in life. Therefore, early detection of social emotional problems is crucial. This study aimed to assess the long-term cost-effectiveness of a population-based screening to detect social-emotional problems with ASQ:SE in 3-year-olds combined with the evidence-based parenting intervention Incredible Years (IY) in Sweden. Methods A decision-analytic Markov model was used to compare two alternatives: 1) all 3-years-olds get screened for social-emotional problems (anxiety and attention deficit hyperactivity (ADH) problems), and parents of children above clinical cutoff receive IY parenting program; 2) no screening and no intervention ("do nothing"). Population and prevalence data on social-emotional problems in 3-year-olds was sourced from Västerbotten Region in Sweden. A cohort of 3-year-olds with social-emotional problems was modelled until 19 years of age, as they transitioned through the states at risk anxiety, ADH problems, and dead. The effectiveness of IY was sourced from published literature. The analyses were conducted from a limited societal perspective including costs of screening, healthcare costs, and productivity losses. Health outcomes were expressed as disability-adjusted life-years (DALYs) averted. Results Screening with ASQ:SE combined with the parenting intervention IY demonstrated lower costs (incremental cost -€102,083) and more DALYs averted (incremental DALYs 16.42) than no screening and no intervention. The combination of screening and intervention strongly dominated the comparator. Conclusions Successful implementation of population-based screening for social-emotional problems combined with an effective evidence-based parenting intervention is good value for money and might be an important way to contribute to sustainable and efficient health care for children in Sweden. Key messages • Poor social-emotional functioning in childhood is a risk factor that has been linked with mental health problems later in life. Therefore, early detection of social emotional problems is crucial. • population-based screening for social-emotional problems combined with an effective evidence-based parenting intervention is good value for money.