title: Economic evaluation of stuttering treatment in preschool children: The RESTART-study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the incremental cost-effectiveness and cost-utility of the Lidcombe Program (LP) compared with treatment based on the Demands and Capacities Model (RESTART-DCM) for preschool children who stutter.
  
  
  METHODS
  A cost-effectiveness and cost-utility analysis were carried out alongside a Randomized Clinical Trial (the RESTART-study). In total, 199 children in 20 speech clinics participated. Outcome measures included the number needed to treat, based on the percentage of children who did not stutter at 18 months, and Health-related Quality of Life (EQ-VAS and HUI3) at 3, 6, 12 and 18 months. Health-related Quality of Life scores were used to calculate quality adjusted life years (V-QALYs for the EQ-VAS and U-QALYs for the HUI3). Direct and indirect costs were measured by cost questionnaires. Missing data were multiply imputed. Percentages of children who did not stutter in both groups were compared by a chi-square test. Between-group differences in mean QALYs and costs, as well as cost effectiveness and cost-utility ratios, were evaluated by applying bootstrapping techniques.
  
  
  RESULTS
  After 18 months, health outcomes were slightly better in the LP group, although only the difference in V-QALYs was statistical significant (0.018; 95% CI: 0.008 to 0.027) with a small effect size (Cohen's d=0.17). Mean costs for the LP group were significantly higher compared to the RESTART-DCM group (€3199 versus €3032), again with a small effect size (Cohen's d=0.14). The incremental cost-effectiveness ratio was €3360 for one additional child who did not stutter with the LP, and the estimated cost-utility ratios were €10,413 (extra cost per extra V-QALY) and €18,617 (extra cost per extra U-QALY). The results indicated a high probability that the LP is cost-effective compared to RESTART-DCM treatment given a threshold for willingness-to-pay of €20,000 per QALY.
  
  
  CONCLUSIONS
  Differences in effects and costs between the LP and RESTART-DCM treatment were small. Cost-effectiveness and cost-utility ratios were in favor of the LP. The LP is considered a good alternative to RESTART-DCM treatment in Dutch primary care.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands; Erasmus University Medical Center, Sophia Children's Hospital, Department of Otorhinolaryngology, Speech and Hearing Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Electronic address: desonneville@bmg.eur.nl.
authors.forename: Caroline
authors.initials: C
authors.lastname: de Sonneville-Koedoot
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
authors.forename: Clazien
authors.initials: C
authors.lastname: Bouwmans
authors.affiliation: Erasmus University Medical Center, Sophia Children's Hospital, Department of Otorhinolaryngology, Speech and Hearing Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Franken
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
authors.forename: Elly
authors.initials: E
authors.lastname: Stolk
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D013070:Speech Therapy / Q000191:economics*; D013342:Stuttering / Q000191:economics* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Costs; Cost–effectiveness; Cost–utility; Demands and Capacities Model; Economic evaluation; Lidcombe Program; Preschool children; RCT; RESTART-study; Stuttering; Treatment