Cost-utility analysis of LEGO based therapy for school children and young people with autism spectrum disorder: results from a randomised controlled trial.

Abstract

Objectives: To assess the cost-effectiveness of LEGO-based therapy compared with usual support.

Design: Cost-utility analysis alongside randomised control trial.

Setting: Mainstream primary and secondary schools in the UK.

Participants: 248 children and young people (CYP) with autism spectrum disorder (ASD) aged 7–15 years.

Intervention: LEGO-based therapy is a group social skills intervention designed specifically for CYP with ASD. Through play, CYP learn to use the skills such as joint attention, sharing, communication and group problem-solving. CYP randomised to the intervention arm received 12 weekly sessions of LEGO-based therapy and usual support, while CYP allocated to control arm received usual support only.

Main outcome measures: Average costs based on National Health Service (NHS) and personal social services perspective and quality-adjusted life years (QALYs) measured by EQ-5D-Y over time horizon of 1 year were collected during the trial. Incremental cost-effectiveness ratio (ICER) was calculated, and non-parametric bootstrapping was conducted. The uncertainty around the ICER estimates was presented using cost-effectiveness acceptability curve (CEAC). A set of sensitivity analyses were conducted to assess the robustness of the primary findings.

Results: After adjustment and bootstrapping, on average, CYP in LEGO-based therapy group incurred less costs (incremental cost was −£251 (95% CI −£752 to £268)) and gained marginal improvement in QALYs (QALYs gained 0.009 (95% CI −0.008 to 0.028)). The CEAC shows that the probability of LEGO-based therapy being cost-effective was 94% at the willingness-to-pay threshold of £20 000 per QALY gained. Results of sensitivity analyses were consistent with the primary outcomes.

Conclusion: Compared with usual support, LEGO-based therapy produced marginal reduction in costs and improvement in QALYs. Results from both primary and sensitivity analyses suggested that LEGO-based therapy was likely to be cost-effective.

Trial registration number: ISRCTN64852382.

Metadata

Authors/Creators:

Wang, H.-I.
Wright, B.D.
Bursnall, M.
Cooper, C. https://orcid.org/0000-0002-2995-5447
Kingsley, E.
Le Couteur, A.
Teare, D.
Biggs, K.
McKendrick, K.
de la Cuesta, G.G.
Chater, T.
Barr, A.
Solaiman, K.
Packham, A.
Marshall, D.
Varley, D.
Nekooi, R.
Gilbody, S.
Parrott, S.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Keywords:

child & adolescent psychiatry; clinical trials; health economics

Dates: