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. 2024 Jun 3;10(4):e123.
doi: 10.1192/bjo.2024.47.

Cost-utility analysis of Social Stories™ for children with autism spectrum disorder in mainstream primary schools: results from a randomised controlled trial

Han-I Wang  1 , Kerry Bell  1 , Jane Blackwell  1 , Charlie Welch  1 , Laura Mandefield  1 , Judith Watson  1 , Emma Standley  1 , Dean McMillan  2 , Simon Gilbody  2 , Barry Wright  3 , Catherine Hewitt  1 , Steve Parrott  1
Affiliations

Cost-utility analysis of Social Stories™ for children with autism spectrum disorder in mainstream primary schools: results from a randomised controlled trial

Han-I Wang et al. BJPsych Open. .

Abstract

Background: One in 57 children are diagnosed with autism in the UK, and the estimated cost for supporting these children in education is substantial. Social Stories™ is a promising and widely used intervention for supporting children with autism in schools and families. It is believed that Social Stories™ can provide meaningful social information to children that can improve social understanding and may reduce anxiety. However, no economic evaluation of Social Stories has been conducted.

Aims: To assess the cost-effectiveness of Social Stories through Autism Spectrum Social Stories in Schools Trial 2, a multi-site, pragmatic, cluster-randomised controlled trial.

Method: Children with autism who were aged 4-11 years were recruited and randomised (N = 249). Costs measured from the societal perspective and quality-adjusted life-years (QALYs) measured by the EQ-5D-Y-3L proxy were collected at baseline and at 6-month follow-up for primary analysis. The incremental cost-effectiveness ratio was calculated, and the uncertainty around incremental cost-effectiveness ratios was captured by non-parametric bootstrapping. Sensitivity analyses were performed to evaluate the robustness of the primary findings.

Results: Social Stories is likely to result in a small cost savings (-£191 per child, 95% CI -767.7 to 337.7) and maintain similar QALY improvements compared with usual care. The probability of Social Stories being a preferred option is 75% if society is willing to pay £20 000 per QALY gained. The sensitivity analysis results aligned with the main study outcomes.

Conclusions: Compared with usual care, Social Stories did not lead to an increase in costs and maintained similar QALY improvements for primary-aged children with autism.

Keywords: Autism spectrum disorders; Social Stories; child and adolescent; cost-effectiveness; quality-adjusted life-years.

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Conflict of interest statement

B.W. is a Trustee of Biomation CEC and co-author of How to Write Social Stories (Jessica Kingsley Publishers), the reference manual distributed to schools as part of the intervention (any small profits from this book are all fully donated to charity). C.H. is a member of the NIHR Clinical Trials Unit Standing Advisory Committee, HTA Post-Funding Committee teleconference (Programme Oversight Committee members to attend), HTA Funding Committee Policy Group (formerly Clinical Studies Group), HTA Commissioning Committee, HTA – Fast Track Funding Committee and HTA Fast Track Committee – June 2021. All royalties are donated to Martin House Children's Hospice. J.W. has received funding for the following: NIHR Efficacy and Mechanism Evaluation (NIHR132622), NIHR HTA Programme (NIHR131483), NIHR Research for Patient Benefit (RfPB) (NIHR201559), NIHR RfPB (NIHR201176), NIHR HTA Programme (NIHR128625), NIHR Trainees Coordinating Centre (Clinical Lectureship) (ICA-CL-2018-04-ST2-015), NIHR Programme Grant (RP-PG-0618-20001), NIHR Programme Grant (NIHR200607), NIHR Programme Grant (RP-PG-0216-20002), NIHR Programme Grants for Applied Research (PGfAR Programme (RP-PG-0615-20003), NIHR PGfAR Programme (RP-PG-1016-20003), NIHR Post-Doctoral Fellowship (NIHR301807), Cancer Research UK (C11232/A23434), NIHR PGfAR Programme (RP-PG-0109-10020), NIHR RfPB (PB-PG-0816-20029), NIHR RfPB (PB-PG-0317-20047). S.P. declares work on the following projects: Yorkshire Cancer Research ESCAPE: Electronic cigarettes as smoking cessation aid for smokers with Mental Illness pilot and full randomised controlled trial; Medical Research Council Global Challenges Research Fund: Tobacco control capacity programme and Medical Research Council Children Learning about Second-hand Smoke: cluster-randomised controlled trial. The rest of the authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Cost-effectiveness plane and cost-effectiveness acceptability curve. QALY, quality-adjusted life-year; WTP, willingness to pay.
Fig. 2
Fig. 2
Cost-effectiveness planes of sensitivity analyses. NHS, National Health Service; PSS, personal social services; QALY, quality-adjusted life-year; WTP, willingness to pay.
See this image and copyright information in PMC

References

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