Cost Effectiveness of School and Home Interventions for Students With Disruptive Behavior Problems

This study examines the cost effectiveness of two interventions for disruptive behavior problems: First Step Next (FSN), a school-based intervention, and a multicomponent intervention that combined FSN with a home-based intervention, homeBase (hB). Analyses were based on findings from a large-scale comparative efficacy trial in the United States (Frey et al., 2022). Intervention costs were estimated using an activities-based ingredients method (Levin & McEwan, 2001). For each disruptive behavior examined (attention-deficit/hyperactivity disorder [ADHD], conduct disorder [CD], and comorbid ADHD and CD), we defined intervention response as movement from the clinical range into the borderline or normative range or from the borderline range into the normative range at post-intervention. Comparative cost-effectiveness analyses involved calculating incremental cost-effectiveness ratios (ICERs), which showed that the combined intervention was always more cost effective. Improvement in comorbid ADHD and CD was the costliest to achieve, followed by CD, and then ADHD. Sensitivity analyses showed that FSN + hB had a high probability of being cost effective across a range of estimates, indicating stakeholder willingness to pay to reduce disruptive behavior problems. This study expands the literature by estimating the costs of implementing a school-based intervention alone or alongside a home-based intervention with elementary students and comparing their cost effectiveness.