Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial

Abstract

Background: Autism is associated with impairments that have life-time consequences for diagnosed individuals and a substantial impact on families. There is growing interest in early interventions for children with autism, yet despite the substantial economic burden, there is little evidence of the cost-effectiveness of such interventions with which to support resource allocation decisions. This study reports an economic evaluation of a parent-mediated, communication-focused therapy carried out within the Pre-School Autism Communication Trial (PACT).

Methods: 152 pre-school children with autism were randomly assigned to treatment as usual (TAU) or PACT + TAU. Primary outcome was severity of autism symptoms at 13-month follow-up. Economic data included health, education and social services, childcare, parental productivity losses and informal care.

Results: Clinically meaningful symptom improvement was evident for 53 % of PACT + TAU versus 41 % of TAU (odds ratio 1.91, p = 0.074). Service costs were significantly higher for PACT + TAU (mean difference £4,489, p < 0.001), but the difference in societal costs was smaller and non-significant (mean difference £1,385, p = 0.788) due to lower informal care rates for PACT + TAU.

Conclusions: Improvements in outcome generated by PACT come at a cost. Although this cost is lower when burden on parents is included, the cost and effectiveness results presented do not support the cost-effectiveness of PACT + TAU compared to TAU alone.

Trial registration: Current Controlled Trials ISRCTN58133827.

Fig. 1

CONSORT flow diagram

Fig. 2

Cost-effectiveness plane using total service costs and ADOS-G score. Cost-effectiveness plane showing the bootstrapped, adjusted differences in total service costs and effects using the proportion of children demonstrating a clinically meaningful improvement in ADOS-G score

Fig. 3

Cost-effectiveness acceptability curve using total service costs and ADOS-G score. Cost-effectiveness acceptability curve showing the probability that PACT + TAU is more cost-effective than TAU alone in terms of total service costs and proportion of children demonstrating a clinically meaningful improvement in ADOS-G score

Fig. 4

Cost-effectiveness plane using total societal costs and ADOS-G score. Cost effectiveness plane showing the bootstrapped, adjusted differences in total societal costs and effects using the proportion of children demonstrating a clinically meaningful improvement in ADOS-G score

Fig. 5

Cost-effectiveness acceptability curve using total societal costs and ADOS-G score. Cost-effectiveness acceptability curve showing the probability that PACT + TAU is more cost-effective than TAU alone in terms of total societal costs and proportion of children demonstrating a clinically meaningful improvement in ADOS-G score

Fig. 6

Cost-effectiveness plane using total service costs and parent synchrony. Cost effectiveness plane showing the bootstrapped, adjusted differences in total service costs and effects using the proportion of parent communications with the child that were synchronous

Fig. 7

Cost-effectiveness acceptability curve using total service costs and parent synchrony. Cost-effectiveness acceptability curve showing the probability that PACT + TAU is more cost-effective than TAU alone in terms of total service costs and proportion of parent communications with the child that were synchronous