Cost-effectiveness of an Intensive Upper Limb Rehabilitation Therapy for Children With Unilateral Cerebral Palsy: an Economic Evaluation of a Randomized Controlled Trial

Abstract

BackgroundUnilateral cerebral palsy (UCP) is a major cause of childhood disability and a substantial economic burden. Intensive group-based therapy of either hybrid constraint-induced movement therapy (mCIMT) or bimanual therapy has been shown to be effective in improving specific domains of the Quality of Life (QoL) in children with this disability. However, there is a paucity of economic evaluation on its role as an adjunct to other therapies currently in use. This study aimed to address this paucity by evaluating whether an intensive group-based therapy model is cost-effective compared to individualized distributed standard care occupational therapy (SC).MethodsAn open-label parallel randomized controlled trial (RCT) and an embedded economic evaluation of intensive group-based hybrid-CIMT (combined mCIMT and bimanual therapy) were conducted. A total of 47 children were randomized to the hybrid-CIMT group (n=27) or the SC (n=20) group. Effectiveness was assessed using the Cerebral Palsy Quality of Life (Child) questionnaire across seven domains: 1) Social well-being and acceptance; 2) Functioning; 3) Participation and physical health; 4) Emotional well-being; 5) Access to services; 6) Pain; and 7) Impact of disability and family health. Using trial data, costs in Australian dollars (AUD) were assessed from a societal perspective. Non-parametric bootstrap analysis was used to quantify uncertainty intervals (UIs; around point estimates) accompanying incremental cost-effectiveness ratio estimates, the cost per unit of beneficial change in the quality of life.ResultsOnly for the domains of Pain (Incremental cost-effectiveness ratio: $273; 95% Uncertainty interval: $107 - $945) and to a lesser extent, Access to services ($1732; -$6448 - $8775) and the Impact of disability and family health ($1071; -$5718 - $4606), was hybrid-CIMT therapy found to be cost-effective when compared to SC. The probability that hybrid-CIMT was cost-effective for the Pain domain was estimated to be 0.50.ConclusionsHybrid-CIMT was not found to be cost-effective when compared to SC over a 13-week time horizon. In order to assess benefits and costs more fully, we recommend that future research utilize time horizons that extend sufficiently into the future. Irrespective of study duration, therapy comparisons should also consider acceptance, equity and feasibility.Trial registrationACTRN12609000912280. 21/10/2009, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000912280