Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial.
Rachael Maree Hunter, Victoria Vickerstaff, Michaela Poppe, Andre Strydom, Michael King, Ian Hall, Jason Crabtree, Rumana Omar, Vivien Cooper, Asit Biswas, Angela Hassiotis
Author Information
Rachael Maree Hunter: Associate Professor, Research Department of Primary Care and Population Health, University College London, UK. ORCID
Victoria Vickerstaff: Senior Research Fellow, PRIMENT Clinical Trials Unit, University College London, UK.
Michaela Poppe: Clinical Trial Manager, Division of Psychiatry, University College London, UK.
Andre Strydom: Professor in Intellectual Disabilities, King's College London and South London and the Maudsley NHS Foundation Trust, UK.
Michael King: Professor of Primary Care Psychiatry, Division of Psychiatry, University College London, UK. ORCID
Ian Hall: Consultant Psychiatrist and Clinical Lead, Community Learning Disability Service, East London NHS Foundation Trust, UK.
Jason Crabtree: Clinical Psychologist, East London NHS Foundation Trust, UK.
Rumana Omar: Professor of Medical Statistics, Department of Statistical Science, University College London, UK.
Vivien Cooper: Chief Executive, Challenging Behaviour Foundation, UK.
Asit Biswas: Consultant Psychiatrist, Agnes Unit, Leicestershire Partnership NHS Trust & University of Leicester, UK. ORCID
Angela Hassiotis: Professor of Psychiatry of Intellectual Disability, Division of Psychiatry, University College London; and Camden and Islington NHS Foundation Trust, UK. ORCID
BACKGROUND: Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs). AIMS: We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276). METHOD: We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective. RESULTS: Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI -0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI -603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold. CONCLUSIONS: There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.
