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Published on: January 11, 2016
Cost-effectiveness analysis of HABIT-ILE in preschool children with bilateral cerebral palsy: a multicenter
Rodolphe Bailly1, Pauline Fracasso2, Sandra Bouvier1
1Fondation ILDYS, SMR Pédiatrique Ty Yann, Brest, France; LaTIM, INSERM UMR1101, Brest, France.
Insights
The HABIT-ILE program significantly improved motor skills in young children with cerebral palsy (CP). This intervention is cost-effective, with an incremental cost-effectiveness ratio (ICER) of €1232 per Gross Motor Function Measure-66 (GMFM-66) point gain.
Area of Science:
- Pediatric Rehabilitation
- Health Economics
- Developmental Pediatrics
Background:
- Cerebral palsy (CP) significantly impacts motor development in preschool children.
- The HABIT-ILE program shows promise in improving motor abilities for children with CP.
- Determining the cost-effectiveness of HABIT-ILE is crucial for its integration into standard healthcare.
Purpose of the Study:
- To evaluate the cost-effectiveness of the early HABIT-ILE intervention compared to usual care for children aged 1-4 with bilateral CP.
- To calculate the incremental cost per Gross Motor Function Measure-66 (GMFM-66) point gain from a societal perspective.
- To compare the effectiveness and costs of HABIT-ILE against usual daily activities and rehabilitation.
Main Methods:
- A multicenter randomized controlled trial was conducted comparing early HABIT-ILE with usual care.
- Micro-costing methods were used to quantify costs from community, healthcare, and family perspectives.
- Effectiveness was measured using the GMFM-66, with data analyzed via ANCOVA and bootstrapped sensitivity analysis for ICER and willingness-to-pay (WTP).
Main Results:
- The HABIT-ILE group showed significantly greater improvement in GMFM-66 scores (+4.10 points) compared to the control group (+0.39 points).
- HABIT-ILE incurred higher costs across all perspectives: Community (€5702 vs €1133), Healthcare (€4144 vs €625), and Family (€1557 vs €472).
- The incremental cost-effectiveness ratio (ICER) for GMFM-66 gain was €1232 from the community perspective.
Conclusions:
- The HABIT-ILE program demonstrated superior motor function improvement in preschool children with bilateral CP compared to usual care.
- An ICER of €1232 per GMFM-66 point is considered cost-effective at a willingness-to-pay threshold of €2000-3000.
- These findings support the integration of the HABIT-ILE program into standard care pathways for children with bilateral CP.
Background:
HABIT-ILE improves motor ability in preschool children with cerebral palsy (CP); however, to support integration into standard care, cost-effectiveness must be determined.
Objectives:
To evaluate the cost-effectiveness of early HABIT-ILE versus usual care in 1-4-year-olds with bilateral CP, using the incremental cost per Gross Motor Function Measure-66 (GMFM-66) point gain, compared to usual daily activities, including usual rehabilitation, from a collective perspective.
Methods:
A multicenter randomized controlled trial compared early HABIT-ILE (50 h over 10 days, partially volunteer-supported) with usual daily activities, including usual rehabilitation. Micro-costing quantified costs from the community, healthcare, and family perspectives. Effectiveness was measured using the GMFM-66 (T0 vs. T2: 90-day follow-up) and analyzed using ANCOVA. Incremental cost-effectiveness ratio (ICER) and willingness-to-pay (WTP) were estimated using bootstrapped sensitivity analysis.
Results:
Thirty-five children were included (mean [SD] age, 37.15 (9.70) months; 43% female; 47% Gross Motor Function Classification System level II). HABIT-ILE generated significantly higher costs than control treatments across all perspectives: i) Community: €5702 vs €1133 (P < 0.05); ii) Healthcare: €4144 vs €625 (P < 0.001); and iii) Family: €1557 vs €472 (P < 0.001). GMFM-66 scores improved significantly more from T0 to T2 in the HABIT-ILE group (+4.10 points for HABIT-ILE and +0.39 points for control, mean difference = 3.71 points, SE = 1.01; d = 1.29; P = 0.002). ICERGMFM was €1232 for the community perspective, reflecting the global per-unit cost increase in GMFM-66. €949 of the ICERGMFM was covered by the healthcare system, and €283 was incurred by families.
Conclusion:
The HABIT-ILE program improved outcomes more than usual care for preschool children with bilateral CP, with an ICER of €1232 per GMFM-66 point, a ratio deemed cost-effective at a WTP of €2000-3000, in an economic research model with the participation of volunteers. These results support the integration of HABIT-ILE into standard care pathways for preschool children with bilateral CP.
