***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To investigate the cost effectiveness of a parenting programme . Design An incremental cost effectiveness analysis alongside a pragmatic r and omised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community . Setting Sure Start areas in north and mid Wales . Participants Parents of 116 children aged 36 - 59 months ( 87 % of the clinical sample ) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory ) . Children were identified by health visitors and recruited by the research team . Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control . Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory . Results The bootstrapped incremental cost effectiveness ratio point estimate was � 73 ( € 109 , $ 142 ) per one point improvement on the intensity score ( 95 % confidence interval � 42 to � 140 ) . It would cost � 5486 ( € 8190 , $ 10 666 ) to bring the child with the highest intensity score to below the clinical cut-off point and � 1344 ( € 2006 , $ 2618 ) to bring the average child in the intervention group within the non- clinical limits on the intensity score ( below 127 ) . For a ceiling ratio of � 100 ( € 149 , $ 194 ) per point increase in intensity score , there is an 83.9 % chance of the intervention being cost effective . The mean cost per child attending the parenting group was � 1934 ( € 2887 , $ 3760 ) for eight children and � 1289 ( € 1924 , $ 2506 ) for 12 children , including initial costs and material s for training group leaders . When we categorised the sample into relatively mild , moderate , and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder . Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective  compared with the waiting list control . This parenting programme involves modest costs and demonstrates strong clinical effect , suggesting it would represent good value for money for public spending The effectiveness of the Incredible Years Basic parent programme ( IYBP ) in reducing child conduct problems and improving parent competencies and mental health was examined in a 12-month follow-up . Pre- to post-intervention service use and related costs were also analysed . A total of 103 families and their children ( aged 32–88 months ) , who previously participated in a r and omised controlled trial of the IYBP , took part in a 12-month follow-up assessment .  Child and parent behaviour and well-being were measured using psychometric and observational measures . An intention-to-treat analysis was carried out using a one-way repeated measures ANOVA . Pairwise comparisons were subsequently conducted to determine whether treatment outcomes were sustained 1 year post-baseline assessment . Results indicate that post-intervention improvements in child conduct problems , parenting behaviour and parental mental health were maintained . Service use and associated costs continued to decline . The results indicate that parent-focused interventions , implemented in the early years , can result in improvements in child and parent behaviour and well-being 12 months later . A reduced reliance on formal services is also indicated BACKGROUND Disruptive behaviour disorders , including conduct disorder , affect at least 10 % of children and are the most common reasons for referral to children 's mental health services . The long-term economic impact on society of unresolved conduct disorder can exceed pound sterling 1 million for one individual over their lifetime . AIMS OF THE STUDY The aim of this study was to estimate , from a multi-sectoral service perspective , the longer term cost-effectiveness of an intensive practice based parenting programme for children with severe behavioural problems as compared to a st and ard treatment , on a pilot basis . METHODS A six-month pragmatic controlled trial was conducted involving forty-two families who had been referred to a Child and Adolescent Mental Health Service ( CAMHS ) because of severe child behavioural problems . The families were r and omly allocated into either the st and ard or intensive , practice -based treatment arms of the trial . At baseline , children were aged 2 to 10 years . The externalising T-scale of the Child Behaviour Check List ( CBCL ) was used as the primary outcome measure . Follow-up studies were conducted at 6 months and four years post-intervention . At the four-year follow up point the two treatments were subjected to an incremental cost-effectiveness analysis . This analysis was enabled by the collection of cost data with respect to the provision of the intensive and st and ard treatments in terms of therapeutic contact time and also participants ' use of health , special educational and social services usage by means of a Client Service Receipt Inventory . RESULTS Both groups exhibited improved behaviour at six month follow-up , but only the practice based treatment group showed sustained improvement at the four-year follow-up . An independent t-test revealed a significant difference between group mean scores at four-year follow-up ( p = 0.027 ) . The research found a median bootstrap ICER estimate of pound sterling 224 From the cost-effectiveness acceptability curve ( CEAC ) it was found that 89.6 % of the cost-effectiveness plane represented a cost saving over the control intervention while 99.9 % represented an improvement in effect . Therefore the intensive intervention could not be said to differ significantly from the control intervention on the basis of costs or effects . However under certain circumstances requiring judgement the intensive intervention could be cost-effective . DISCUSSION Training interventions for the parents of children with severe conduct disorders currently take the form of a number of behavioural strategies provided by a CAMHS team including the reinforcement of appropriate behaviours and parent record-keeping . An alternative treatment was then considered that included all the aspects provided by the st and ard treatment ( with the exception of agreeing written goals ) and also added five-hour sessions of unit-based treatment during which videotaped recording of parent-child interactions were used to give feedback to parents and to provide the opportunity for behavioural rehearsal . The findings of the current research indicate that this alternative treatment may be more cost-effective than the st and ard intervention under certain circumstances . CONCLUSIONS It can be concluded on a pilot basis that while the CEAC failed to show a significant difference between costs and effects for the intensive treatment , under circumstances of re source /effect trade offs the treatment could be said to be cost-effective . IMPLICATION S FOR HEALTH CARE PROVISION , USE AND POLICIES : Health and social care policy and commissioning must be evidence based . Although the analysis in this paper should be considered a pilot due to the small sample size our results suggest that investment by health services and social services in practice -based parenting interventions may well be less costly and more effective in the longer-run than the st and ard practice involving giving management advice to parents . IMPLICATION S FOR FURTHER RESEARCH It would be of interest for further research to continue to follow up the work done in this study with a larger cohort of subjects to further establish the effective components of parenting programmes and their relative costs and benefits both at intervention and over time Objective To evaluate the effectiveness and cost utility of a universally provided early years parenting programme . Design Multicentre r and omised controlled trial with cost-effectiveness analysis . Setting Early years centres in four deprived areas of South Wales . Participants Families with children aged between 2 and 4 years . 286 families were recruited and r and omly allocated to the intervention or waiting list control . Intervention The Family Links Nurturing Programme ( FLNP ) , a 10-week course with weekly 2 h facilitated group sessions . Main outcome measures Negative and supportive parenting , child and parental well-being and costs assessed before the intervention , following the course ( 3 months ) and at 9 months using st and ardised measures . Results There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months . With ‘ + ’ indicating improvement , difference in change in negative parenting score at 9 months was + 0.90 ( 95%CI −1.90 to 3.69 ) ; in supportive parenting , + 0.17 ( 95%CI −0.61 to 0.94 ) ; and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm . Based on changes in parental well-being ( SF-12 ) , the cost per quality -adjusted life year ( QALY ) gained was estimated to be £ 34 913 ( range 21 485–46 578 ) over 5 years and £ 18 954 ( range 11 664–25 287 ) over 10 years . Probability of cost per QALY gained below £ 30 000 was 47 % at 5 years and 57 % at 10 years . Attendance was low : 34 % of intervention families attended no sessions ( n=48 ) ; only 47 % completed the course ( n=68 ) . Also , 19 % of control families attended a parenting programme before 9-month follow-up . Conclusions Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting . However , low levels of exposure and contamination mean that uncertainty remains . Trial registration The trial is registered with Current Controlled Trials IS RCT N13919732 BACKGROUND Parenting styles and parent-child relationships are a determinant of emotional and behavioural problems in children . Controlled trials of parenting programmes have been shown to be effective in helping parents of children with clinical levels of behaviour problems , but there is little research on the impact of such programmes in families where children 's development falls in the ' normal ' range . Also , such trials do not shed light on why or how programmes do , or do not , work , or how they might be improved . METHODS A qualitative study of the impact of the Webster-Stratton ' Parents and Children Series ' programme  on participants in a controlled trial of this programme , whose children 's behaviour was below average , but , for the majority , in the normal range . Data were gathered in interviews , open-ended questions on a question naire and tape recordings of group leader supervision sessions . RESULTS Parents reported increased confidence , better relationships with their children , successful use of new behaviour management techniques and improvements in their children 's behaviour as a result of the programme . One parent found the programme unsuitable because she was already using the techniques that were taught , and another parent felt the programme was design ed for parents of younger children . Many parents reported that additional sessions would have been useful to consoli date what they had learnt , and some parents felt the course would have been more effective if their partners had attended . CONCLUSIONS The Webster-Stratton Parenting Programme is useful for parents of ' normal ' children as well as for parents of children whose behaviour is in the clinical range . Follow-up sessions and attendance by both parents might increase effectiveness . The findings of this study suggest greater benefits to parents and children than were apparent in the controlled trial Complex interventions , such as parenting programs , are rarely evaluated from a public sector , multi-agency perspective . An exception is the Incredible Years ( IY ) Basic Parenting Program ; which has a growing clinical and cost-effectiveness evidence base for preventing or reducing children ’s conduct problems . The aim of this paper was to provide a micro-costing framework for use by future research ers , by micro-costing the  12-session IY Toddler Parenting Program  from a public sector , multi-agency perspective . This micro-costing was undertaken as part of a community-based r and omized controlled trial of the program in disadvantaged Flying Start areas in Wales , U.K. Program delivery costs were collected by group leader cost diaries . Training and supervision costs were recorded . Sensitivity analysis assessed the effects of a London cost weighting and group size . Costs were reported in 2008/2009 pounds sterling . Direct program initial set-up costs were £ 3305.73 ; recurrent delivery costs for the program based on eight parents attending a group were £ 752.63 per child , falling to £ 633.61 based on 10 parents . Under research context s ( with weekly supervision ) delivery costs were £ 1509.28 per child based on eight parents , falling to £ 1238.94 per child based on 10 parents . When applying a London weighting , overall program costs increased in all context s. Costs at a micro-level must be accurately calculated to conduct meaningful cost-effectiveness/cost-benefit analysis . A st and ardized framework for assessing costs is needed ; this paper outlines a suggested framework . In prevention science it is important for decision makers to be aware of intervention costs in order to allocate scarce re sources effectively Early onset of behavioural problems has lasting negative effects on a broad range of lifetime outcomes , placing large costs on individuals , families and society . A number of research ers and policy makers have argued that early interventions aim ed at supporting the family is the most effective way of tackling child behaviour problems . This study forms the economic component of a r and omised evaluation of the Incredible Years programme , a programme aim ed at improving the skills and parenting strategies of parents of children with conduct problems . Our results show that the programme provides a cost-effective way of reducing behavioural problems . Furthermore , our cost analysis , when combined with a consideration of the potential long-run benefits , suggests that investment in such programmes may generate favourable long-run economic returns BACKGROUND Recent review s have shown that home visiting programmes that address parenting have the potential to improve long term health and social outcomes for children . However there are few studies exploring the cost-effectiveness of such interventions . The objective of this study was to evaluate the cost-effectiveness of an intensive home visiting programme directed at vulnerable families during the antenatal and postnatal periods . METHODS The design was an economic evaluation alongside a multicentre r and omized controlled trial , in which 131 eligible women were r and omly allocated to receive 18 months of intensive home visiting ( n=67 ) or st and ard services ( n=64 ) . Due to the public health nature of the intervention a cost-effectiveness analysis was undertaken from a societal perspective . RES 
    Output:
    
RESULTS Despite existing economic studies generally focusing upon targeted short-run outcomes , significant savings were observed in the included studies .
Parenting interventions could save the health service around £ 2.5k per family over 25 years and could save the criminal justice system over £ 145k per person over the life course .
In light of the escalating costs of remedial services , these potential savings may provide the UK and other governments with a robust incentive to invest in early years parenting interventions .
Parenting interventions can be economically efficient and return savings on investment .
Moreover , and one might argue as a moral imperative of democratic societies , population health can be improved and health inequalities reduced .