Intensive behavioural interventions based on applied behaviour analysis (ABA) for young children with autism: A cost-effectiveness analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
04
10
2021
accepted:
20
06
2022
entrez:
16
8
2022
pubmed:
17
8
2022
medline:
19
8
2022
Statut:
epublish
Résumé
The economic and social costs of autism are significant. This study evaluates the cost-effectiveness of early intensive Applied Behaviour Analysis (ABA)-based interventions for autistic pre-school children in the UK. A de novo economic analysis was developed in Microsoft Excel comparing early intensive ABA-based interventions compared with treatment as usual (TAU). The analysis used 15.5-year time horizon, with costs and benefits discounted a 3.5%. The model structure was based on cohort structure to capture changes in adaptive behaviour and cognitive ability over time. The analysis was informed by an individual patient data (IPD) meta-analysis of available evidence. Adopting a public sector perspective, early intensive ABA-based therapies were associated with greater incremental costs and greater benefits. When pessimistic assumptions were made regarding the long-term effects of treatment incremental costs were £46,103 and incremental quality-adjusted life years (QALYs) were 0.24, resulting in an incremental cost-effectiveness ratio (ICER) of £189,122 per quality-adjusted life year (QALY). When optimistic assumptions were made about long-term effects, incremental costs were £39,233 with incremental benefits of 0.84 QALYs. The resulting ICER was £46,768 per QALY. Scenario analyses emphasised the importance of assumptions made regarding adult outcomes and type of school attended, both of which significantly affect the results of the analysis. The results of this economic analysis suggest that early intensive ABA-based interventions are unlikely to represent value for money, based on a £20,000 to £30,000 per QALY threshold typically adopted to inform UK healthcare funding decisions. However, important gaps in the available evidence, limit the strength of the conclusions that can be drawn from the presented analysis. Further research, focusing on the trajectory of autistic children following intervention is likely to be highly beneficial to resolving some of these uncertainties.
Sections du résumé
BACKGROUND
The economic and social costs of autism are significant. This study evaluates the cost-effectiveness of early intensive Applied Behaviour Analysis (ABA)-based interventions for autistic pre-school children in the UK.
METHODS
A de novo economic analysis was developed in Microsoft Excel comparing early intensive ABA-based interventions compared with treatment as usual (TAU). The analysis used 15.5-year time horizon, with costs and benefits discounted a 3.5%. The model structure was based on cohort structure to capture changes in adaptive behaviour and cognitive ability over time. The analysis was informed by an individual patient data (IPD) meta-analysis of available evidence.
RESULTS
Adopting a public sector perspective, early intensive ABA-based therapies were associated with greater incremental costs and greater benefits. When pessimistic assumptions were made regarding the long-term effects of treatment incremental costs were £46,103 and incremental quality-adjusted life years (QALYs) were 0.24, resulting in an incremental cost-effectiveness ratio (ICER) of £189,122 per quality-adjusted life year (QALY). When optimistic assumptions were made about long-term effects, incremental costs were £39,233 with incremental benefits of 0.84 QALYs. The resulting ICER was £46,768 per QALY. Scenario analyses emphasised the importance of assumptions made regarding adult outcomes and type of school attended, both of which significantly affect the results of the analysis.
CONCLUSIONS
The results of this economic analysis suggest that early intensive ABA-based interventions are unlikely to represent value for money, based on a £20,000 to £30,000 per QALY threshold typically adopted to inform UK healthcare funding decisions. However, important gaps in the available evidence, limit the strength of the conclusions that can be drawn from the presented analysis. Further research, focusing on the trajectory of autistic children following intervention is likely to be highly beneficial to resolving some of these uncertainties.
Identifiants
pubmed: 35972929
doi: 10.1371/journal.pone.0270833
pii: PONE-D-21-31871
pmc: PMC9380934
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0270833Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Child Psychol Psychiatry. 2004 Feb;45(2):212-29
pubmed: 14982237
Curr Opin Psychiatry. 2017 Mar;30(2):69-76
pubmed: 28067726
Behav Modif. 2011 Sep;35(5):427-50
pubmed: 21586502
J Autism Dev Disord. 2008 Jan;38(1):72-85
pubmed: 17340200
Autism Res. 2009 Apr;2(2):109-18
pubmed: 19455645
Autism. 2009 May;13(3):317-36
pubmed: 19369391
J Autism Dev Disord. 2005 Jun;35(3):351-60
pubmed: 16119476
J Am Acad Child Adolesc Psychiatry. 2013 Jun;52(6):572-81.e1
pubmed: 23702446
Arch Gen Psychiatry. 2011 May;68(5):459-65
pubmed: 21536975
Behav Modif. 2019 Mar;43(2):181-201
pubmed: 29241355
Annu Rev Public Health. 2017 Mar 20;38:81-102
pubmed: 28068486
J Consult Clin Psychol. 1987 Feb;55(1):3-9
pubmed: 3571656
Autism Res. 2014 Dec;7(6):649-63
pubmed: 25255789
J Autism Dev Disord. 2000 Jun;30(3):205-23
pubmed: 11055457
J Autism Dev Disord. 2015 Apr;45(4):966-74
pubmed: 25239176
Med Decis Making. 1993 Oct-Dec;13(4):322-38
pubmed: 8246705
JAMA Netw Open. 2018 Aug 3;1(4):e181465
pubmed: 30646131
Behav Modif. 2021 Jul;45(4):581-601
pubmed: 31619051
J Autism Dev Disord. 2014 Aug;44(8):1933-45
pubmed: 24577786
Res Dev Disabil. 2012 Nov-Dec;33(6):1763-72
pubmed: 22705454
Am J Ment Retard. 2000 Jul;105(4):269-85
pubmed: 10934569
J Autism Dev Disord. 2015 Sep;45(9):2833-47
pubmed: 25936527
Health Technol Assess. 2020 Jul;24(35):1-306
pubmed: 32686642
Am J Med Genet C Semin Med Genet. 2015 Jun;169(2):198-208
pubmed: 25959391
Br J Psychiatry. 2005 Aug;187:106-8
pubmed: 16055820
Autism. 2021 May;25(4):1137-1153
pubmed: 33482692
J Autism Dev Disord. 2015 Aug;45(8):2411-28
pubmed: 25737021
Br J Psychiatry. 2016 Mar;208(3):232-8
pubmed: 26541693
JAMA Pediatr. 2014 Aug;168(8):721-8
pubmed: 24911948
JAMA Psychiatry. 2015 May;72(5):483-9
pubmed: 25806797
Autism. 2015 Oct;19(7):814-23
pubmed: 25911091
Behav Modif. 2020 Jan;44(1):3-26
pubmed: 30009626
Autism Res. 2020 Sep;13(9):1548-1560
pubmed: 32851813
Autism. 2011 Jan;15(1):7-20
pubmed: 20923888
Health Technol Assess. 2015 Jun;19(41):1-506
pubmed: 26065374
J Child Psychol Psychiatry. 2014 May;55(5):485-94
pubmed: 24313878
Can J Psychiatry. 2012 May;57(5):275-83
pubmed: 22546059
Behav Modif. 2007 May;31(3):264-78
pubmed: 17438342
J Child Psychol Psychiatry. 2020 Jul;61(7):760-767
pubmed: 31957035
J Autism Dev Disord. 2016 Jun;46(6):1974-1984
pubmed: 27032954
J Am Acad Child Adolesc Psychiatry. 2015 Jul;54(7):580-7
pubmed: 26088663
Dev Psychopathol. 2008 Summer;20(3):775-803
pubmed: 18606031
Lancet. 2006 Jul 15;368(9531):210-5
pubmed: 16844490
J Autism Dev Disord. 2012 Feb;42(2):161-74
pubmed: 22187106
Autism. 2015 Jul;19(5):562-9
pubmed: 24913778