Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial

Abstract

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.

Behaviours that challenge in adults with intellectual disability: overview of assessment and management

“…However, clear evidence drawn from large randomised controlled trials is still lacking and the health economic evaluation of psychological interventions in the field of intellectual disabilities is in its infancy, with only a few studies including such approaches (Hunter 2020). Both of those are necessary conditions for the rollout of the interventions in intellectual disabilities services in the NHS and beyond.…”

“…Since the publication of NICE guidelines on interventions for challenging behaviour in people with intellectual disabilities (NICE 2015a), there is cautious optimism generated by emerging directions in understanding the underlying aetiologies of such behaviour and the relative proliferation of adapted or newly developed psychosocial therapies for its management. However, clear evidence drawn from large randomised controlled trials is still lacking and the health economic evaluation of psychological interventions in the field of intellectual disabilities is in its infancy, with only a few studies including such approaches (Hunter 2020). Both of those are necessary conditions for the rollout of the interventions in intellectual disabilities services in the NHS and beyond.…”

A manualised weight management programme for adults with mild–moderate intellectual disabilities affected by excess weight: A randomised controlled feasibility trial (Shape Up‐LD)*

“…Following feedback from participants, we moved to the youth version of the EQ‐5D, the language of which they found easier to understand. A study in a more severe population found that the EQ‐5D‐Y was sensitive to changes in challenging behaviour, although this was predominately completed by proxies (Hunter et al, 2020). We, therefore, suggest the EQ‐5DY be considered for use in future studies with this population.…”

The Effects of Integrated Step Training into the Physical Education Curriculum of Children with Intellectual Disabilities

“…Similarly, for individuals with intellectual disabilities, maintaining or improving upon their performance in the activities of daily life is difficult due to their various limitations, which may also affect their performance in the workplace [ 27 ]. As individuals with intellectual disabilities physically and mentally develop more slowly than those without intellectual disabilities, greater attention should be paid to their physical and mental health concerns [ 2 , 28 ]. Especially in adolescence, the lack of proper physical stimulation may inhibit the normal development of organs and tissues [ 29 ].…”