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Cost-Effectiveness of an Intensive Upper Limb Rehabilitation Therapy for Children With Unilateral Cerebral Palsy: An
Michael C David1,2, Hideki Higashi3
1School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.
Insights
Intensive therapy for unilateral cerebral palsy improved quality of life but was not consistently cost-effective. Only the pain and disability domain showed a high probability of being cost-effective over 13 weeks.
Area of Science:
- Pediatric Rehabilitation
- Health Economics
- Childhood Disability Studies
Background:
- Unilateral cerebral palsy (UCP) significantly impacts childhood disability and incurs substantial economic costs.
- Intensive group-based therapy, combining constraint-induced movement and bimanual therapies, shows promise for improving UCP-related quality of life.
- Assessing the cost-effectiveness of this intensive intervention against standard care is crucial for resource allocation.
Purpose of the Study:
- To evaluate the cost-effectiveness of an intensive, hybrid therapy intervention for children with unilateral cerebral palsy compared to standard care.
- To analyze the impact of the intervention on various quality-of-life domains as measured by the Cerebral Palsy Quality of Life (Child) questionnaire.
Main Methods:
- An open-label, parallel randomized controlled trial with an embedded economic evaluation.
- 47 children with UCP were randomized into an intervention group (n=27) or a standard care group (n=20).
- Nonparametric bootstrapping was utilized to determine uncertainty intervals for incremental cost-effectiveness ratios.
Main Results:
- The intervention demonstrated incremental cost-effectiveness ratios ranging from $107 to $1071 for the Family Health domain.
- For the Pain and Impact of Disability domain, the intervention showed a probability exceeding 0.75 of being cost-effective.
- Cost-effectiveness was not sufficiently demonstrated for other domains within the 13-week study period.
Conclusions:
- The intensive hybrid therapy intervention for unilateral cerebral palsy shows potential cost-effectiveness specifically for the Pain and Impact of Disability domain.
- Insufficient evidence exists to support the cost-effectiveness of this intervention over standard care for other quality-of-life domains within a 13-week timeframe.
- Further research may be needed to explore long-term cost-effectiveness and broader applicability of the intervention.
Abstract:
Background: Unilateral cerebral palsy is a major cause of childhood disability and a substantial economic burden. Intensive group-based therapy, consisting of hybrid constraint-induced movement and bimanual therapies, has been shown to be effective in improving specific quality-of-life domains in children with this disability. Our objective in this study was to assess if this intervention was cost-effective compared with standard care. Methods: An open-label, parallel, randomized controlled trial with an embedded economic evaluation of the intervention was conducted. A total of 47 children were randomized to either the intervention group (n = 27) or the standard care (n = 20) group. The effectiveness of the intervention was assessed using the Cerebral Palsy Quality of Life (Child) questionnaire across several domains. Nonparametric bootstrapping was used to quantify uncertainty intervals (UIs) for incremental cost-effectiveness ratios. Results: The incremental cost-effectiveness ratios for the intervention were 107 to 1071 (95% UI: -4606) for Family Health and 6448 to 1000, only for the Pain and Impact of Disability domain was the intervention likely to have a probability of being cost-effective exceeding 0.75. Conclusions: Other than the Pain and Impact of Disability domain, there was insufficient evidence demonstrating the intervention to be cost-effective over a 13-week time horizon.
