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

Abstract

ObjectivesTo assess the cost-effectiveness of LEGO-based therapy compared with usual support.DesignCost-utility analysis alongside randomised control trial.SettingMainstream primary and secondary schools in the UK.Participants248 children and young people (CYP) with autism spectrum disorder (ASD) aged 7–15 years.InterventionLEGO-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 measuresAverage 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.ResultsAfter 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.ConclusionCompared 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 numberISRCTN64852382.

Cost and effectiveness of one session treatment (OST) for children and young people with specific phobias compared to multi-session cognitive behavioural therapy (CBT): results from a randomised controlled trial

“…The SURE approach considers the distribution of the dependent variable as well as the correlation between cost and QALY outcomes [31]; while non-parametric bootstrap re-sampling method was suggested by Briggs and colleagues [43], as the distribution of regression residuals was likely to be skewed [44]. The number of 5000 iterations was chosen because it was considered to be sufficient to generate robust estimates of standard errors [43] and is widely used in trial-based cost-effectiveness analyses for mental health illness [45][46][47]. Covariates, such as baseline utility, cost, age, gender, and study site, were chosen based on the related cost utility analysis (CUA) study for mental health illness [47].…”

“…The number of 5000 iterations was chosen because it was considered to be sufficient to generate robust estimates of standard errors [43] and is widely used in trial-based cost-effectiveness analyses for mental health illness [45][46][47]. Covariates, such as baseline utility, cost, age, gender, and study site, were chosen based on the related cost utility analysis (CUA) study for mental health illness [47]. Phobia type and ADIS CSR scores were chosen because they reflect the disease type and severity, which are considered by experts to be relevant to costs and QALYs.…”

I-SOCIALISE: Results from a cluster randomised controlled trial investigating the social competence and isolation of children with autism taking part in LEGO® based therapy (‘Play Brick Therapy’) clubs in school environments

“…Health economics analysis results indicate that, compared to usual support only, LEGO ® based therapy and usual support produced marginal but robust reduction in costs and improvement in quality-adjusted life years from both perspectives, suggesting it is likely to be cost-effective. Details and results are reported elsewhere ( Wang et al, 2022a ).…”

“…Given the high rates of co-occurring emotional and behavioural difficulties reported for most autistic children and young people, and the importance of investigating the potential impact of LEGO ® based therapy on other aspects of everyday functioning, a range of standardised measures were used to assess secondary objectives including perceived isolation, academic competence, assertion, social control, externalising and internalising, and emotional and behavioural symptoms. Intervention cost-effectiveness, fidelity and acceptability were also investigated and are reported elsewhere ( Barr et al, 2022 ; Wang et al, 2022a ; Wright et al, in press ).…”

“…Primary care and community services also provided a range of therapeutic and/or clinical services. Comparison between groups is reported elsewhere ( Wang et al, 2022a ).…”