Evidence map›Paper›PMID 32019635›Full record

ArticleBJPsych open2020

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 and 1 more

Registry-linked trialAbstract read
In one paragraph

Article in BJPsych open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01680276 (Clinical and Cost Effectiveness of Staff Training in Positive Behaviour Support), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01680276 phase3unknown statusnot on this map

Clinical and Cost Effectiveness of Staff Training in Positive Behaviour Support (PBS) for Treating Challenging Behaviour in People With Intellectual Disability: A Cluster Randomised Controlled Trial

TypeinterventionalSponsorUniversity College, LondonRan2012 to 2016Enrolled246ConditionsChallenging BehaviourArmsPBS based staff training, Treatment as Usual
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Rachael Maree HunterAssociate Professor, Research Department of Primary Care and Population Health, University College London, UK.ORCID https://orcid.org/0000-0002-7447-8934
Victoria VickerstaffSenior Research Fellow, PRIMENT Clinical Trials Unit, University College London, UK.
Michaela PoppeClinical Trial Manager, Division of Psychiatry, University College London, UK.
Andre StrydomProfessor in Intellectual Disabilities, King's College London and South London and the Maudsley NHS Foundation Trust, UK.
Michael KingProfessor of Primary Care Psychiatry, Division of Psychiatry, University College London, UK.ORCID https://orcid.org/0000-0003-4715-7171
Ian HallConsultant Psychiatrist and Clinical Lead, Community Learning Disability Service, East London NHS Foundation Trust, UK.
Jason CrabtreeClinical Psychologist, East London NHS Foundation Trust, UK.
Rumana OmarProfessor of Medical Statistics, Department of Statistical Science, University College London, UK.
Vivien CooperChief Executive, Challenging Behaviour Foundation, UK.
Asit BiswasConsultant Psychiatrist, Agnes Unit, Leicestershire Partnership NHS Trust & University of Leicester, UK.ORCID https://orcid.org/0000-0003-0184-6289
Angela HassiotisProfessor of Psychiatry of Intellectual Disability, Division of Psychiatry, University College London; and Camden and Islington NHS Foundation Trust, UK.ORCID https://orcid.org/0000-0002-9800-3909

Funding

Marie Curie MCCC-FCO-11-U
6 · The paper itself

Abstract

backgroundBehaviour 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).

aimsWe 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).

methodWe 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.

resultsOver 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.

conclusionsThere 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.

Indexed as

cost-effectivenessIntellectual disabilityrandomized controlled trial

Identifiers

PMID32019635
PMCPMC7176891

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.