A post-diagnostic psycho-education, acceptance and commitment therapy programme for caregivers of children recently...

Caregivers of autistic children experience higher rates of mental health difficulties, caregiving complexities, and employment challenges, resulting in reduced health status and productivity losses. We evaluated the cost-effectiveness of a group psychosocial intervention (Empower-Autism) plus treatment as usual (TAU), in comparison to TAU alone, for caregivers of children recently diagnosed with ASD.

A multicentre, assessor-masked, randomised controlled trial of 379 primary caregivers of children with a recent ASD diagnosis in North-West England prospectively collected economic data. The trial (ISRCTN 45412843) was prospectively registered on Sept 11, 2019 and participants were referred and screened for inclusion between Sept 16, 2020 and April 14, 2022. The final data extract was performed on Aug 31, 2023. The primary outcome of the cost-effectiveness analysis was quality-adjusted life years (QALYs) at 52-week follow-up. Missing data were imputed using multiple imputation. Uncertainty was explored by probabilistic bootstrapping. Sensitivity analyses tested the impact of study design and assumptions on the incremental cost-effectiveness ratio (ICER).

Primary (imputed data) and complete case analyses have contrasting results; the complete case suggests the intervention may be cost-effective (net cost £786; net QALY 0.049; ICER ∼£16 k) in contrast to the primary analysis (net cost £756; net QALY 0.015; ICER ∼£51 k). Using the GHQ-30 (trial primary outcome, measuring mental health) as an alternative measure of benefit resulted in a cost of £150 per point improvement (statistically significant health gain, clinically meaningful at ∼£750/individual).

The proportion of participants with incomplete data, likely in part due to the COVID-19 pandemic, results in uncertainty. However, there is some indication that the intervention is cost-effective. Further research is needed to explore the potential longer-term cost-effectiveness of Empower-Autism.

NIHRHTA Programme (17/80/09).