Cost, Cost-Effectiveness, and Cost-Benefit of Attachment Biobehavioral Catch-up (ABC)

Attachment Biobehavioral Catch-up (ABC) is a home visiting program that teaches caregivers how to provide sensitive and nurturing care to their children (Dozier, 2010; Dozier & Bernard, 2019). Although the effectiveness of ABC has been evaluated previously, the intervention has yet to undergo an evaluation of its costs and cost-effectiveness. We assessed and compared costs of delivering ABC in research and real-world settings from four perspectives (client, provider, administrator, and overall). The current study found that ABC was significantly more costly from all four perspectives when delivered in a real-world setting (overall median: $2,502) than a controlled setting (overall median: $1,661). When comparing costs of ABC to an active control intervention from a randomized controlled trial, ABC was significantly more expensive than the control intervention from only the administrative perspective, but not from the client, provider, and overall perspectives. With regard to effectiveness, results indicated that (a) caregivers receiving ABC significantly increased their sensitivity and nonintrusiveness from pre- to posttreatment, (b) children whose caregivers received ABC had significantly higher rates of organized attachment, and (c) children whose caregivers received ABC had marginally higher cortisol levels at wake-up and significantly steeper cortisol slope from wake-up to bedtime on Days 1 and 2 than children with caregivers who received Developmental Education for Families (DEF). No significant differences were found between ABC and DEF for children’s attachment security. Individual cost-effectiveness ratios examined costs of producing a one-unit change in ABC parenting skills as well as children’s cortisol slope. We also discussed a framework for conducting a cost-benefit analysis of ABC in the future. Results from the current study support the expansion of ABC, as it enhances stakeholders’ understanding of the value of resources essential for delivering ABC.