title: 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.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN58133827.
authors.affiliation: King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK. s.byford@kcl.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Byford
authors.affiliation: King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK. maria.1.cary@kcl.ac.uk.
authors.forename: Maria
authors.initials: M
authors.lastname: Cary
authors.affiliation: King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK. barbara.m.barrett@kcl.ac.uk.
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
authors.affiliation: Stockport NHS Foundation Trust, Stockport, SK2 7JE, UK. craldred@tiscali.co.uk.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Aldred
authors.affiliation: Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK. tony.charman@kcl.ac.uk.
authors.forename: Tony
authors.initials: T
authors.lastname: Charman
authors.affiliation: Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK. patricia.howlin@kcl.ac.uk.
authors.forename: Patricia
authors.initials: P
authors.lastname: Howlin
authors.affiliation: Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. k.hudry@latrobe.edu.au.
authors.forename: Kristelle
authors.initials: K
authors.lastname: Hudry
authors.affiliation: Institute for Brain, Behaviour and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK. kathy.leadbitter@manchester.ac.uk.
authors.forename: Kathy
authors.initials: K
authors.lastname: Leadbitter
authors.affiliation: Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. a.s.le-couteur@newcastle.ac.uk.
authors.forename: Ann
authors.initials: A
authors.lastname: Le Couteur
authors.affiliation: Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. helen.mcconachie@newcastle.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: McConachie
authors.affiliation: Biostatistics, Box P020, King`s College London, De Crespigny Park, London, SE5 8AF, UK. andrew.pickles@kcl.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pickles
authors.affiliation: Evelina Children`s Hospital, King`s College London, London, SE1 7EH, UK. vicky.Slonims@gstt.nhs.uk.
authors.forename: Vicky
authors.initials: V
authors.lastname: Slonims
authors.affiliation: Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. kathryntemple2000@yahoo.com.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Temple
authors.affiliation: Manchester Academic Health Sciences Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. jonathan.green@manchester.ac.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Green
mesh_terms: D001321:Autistic Disorder / Q000191:economics* / Q000628:therapy*; D002675:Child, Preschool; D003142:Communication; D003362:Cost-Benefit Analysis; D061345:Early Medical Intervention; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010290:Parents; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D012574:Schools / Q000191:economics; D012946:Social Welfare / Q000191:economics