We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Estimated Therapy Costs and Downstream Cost Consequences of iBASIS–Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia.
- Authors
Segal, Leonie; Green, Jonathan; Twizeyemariya, Asterie; Hudry, Kristelle; Wan, Ming Wai; Barbaro, Josephine; Iacono, Teresa; Varcin, Kandice J.; Pillar, Sarah; Cooper, Matthew N.; Billingham, Wesley; Upson, Gemma; Whitehouse, Andrew J. O.
- Abstract
Key Points: Question: Is iBASIS–Video Interaction to Promote Positive Parenting (iBASIS- VIPP) therapy, a preemptive intervention for infants displaying early behavioral signs of autism, a good societal investment from a third-party payer perspective? Findings: In this economic evaluation of 89 children with follow-up data from an iBASIS-VIPP randomized clinical trial in Australia, the intervention was estimated to cost A $5131 (US $3607) per child and deliver a cost savings of A $10 695 (US $7519) per child (modeled to age 12 years). In addition, for each dollar invested in treatment, the savings in third-party payer costs was estimated to be A $3.08 (US $3.08). Meaning: These findings suggest that improvement in child developmental outcomes in the iBASIS-VIPP trial was achieved at an expected net cost savings to the Australian government and that iBASIS-VIPP is a likely good-value societal investment. This economic evaluation assesses the estimated net costs of the iBASIS–Video Interaction to Promote Positive Parenting intervention vs usual care among children with early behavioral signs of autism in Australia. Importance: The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. Objective: To estimate the net cost impact of the iBASIS–Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Design, Setting, and Participants: Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. Exposures: iBASIS-VIPP intervention. Main Outcomes and Measures: To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Results: Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. Conclusions and Relevance: The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.
- Subjects
AUSTRALIA; DIAGNOSIS of autism; PARENTING education; CONFIDENCE intervals; MEDICAL care costs; COST control; RESEARCH funding; COST analysis; VIDEO recording
- Publication
JAMA Network Open, 2023, Vol 6, Issue 4, pe235847
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.5847