A New Post-Diagnostic Psycho-Education and Acceptance and Commitment Therapy Program for Caregivers of Children Recently Diagnosed With Autism Spectrum Disorder (REACH-ASD): A Trial-Based Cost-Effectiveness Analysis

OBJECTIVES: Caregivers of children with Autism Spectrum Disorder (ASD) have been noted to experience higher rates of mental health difficulties and employment challenges, resulting in reduced health status and productivity losses. In the UK, the National Institute for Health and Care Excellence (NICE) recommend provision of timely post-diagnostic family support. The REACH-ASD randomized controlled trial (RCT) aimed to evaluate both the clinical and cost-effectiveness of a new brief manualized psychosocial intervention (Empower-Autism) plus treatment as usual (TAU), in comparison to TAU alone, for caregivers of children recently diagnosed with ASD.

METHODS: A multicenter, single-blind, randomized controlled trial of 379 primary caregivers of children with a recent ASD diagnosis prospectively collected economic data (service use, health status and productivity losses). The primary outcome of the cost-effectiveness analysis was quality-adjusted life-years (QALYs). The time horizon of the primary analysis was 52-week follow-up. Missing data were imputed using multiple imputation. Uncertainty was explored by probabilistic bootstrapping. Sensitivity analyses tested the impact of the study design and assumptions on the incremental cost-effectiveness ratio (ICER).

RESULTS: The primary and complete case analyses have contrasting ICERs and probability of cost-effectiveness; with the complete case analysis ICER suggesting that intervention may be cost-effective (net cost £786; net QALY 0.049; ICER ~£16k) in contrast to the primary analysis (net cost £756; net QALY 0.015; ICER ~£51k). Using the GHQ-30 (trial primary outcome), which focuses on mental health, as an alternative measure of benefit resulted in a cost of £150 per point improvement.

CONCLUSIONS: The proportion of participants with complete data (33%), likely in part due to the COVID-19 pandemic, results in substantial uncertainty. The analyses indicate that there are situations in which intervention could be cost-effective (e.g. including both parent and child QALYs, using alternative measures of health, adjustments to intervention delivery and taking a societal perspective).