Cost-Effectiveness of an Intensive Upper Limb Rehabilitation Therapy for Children With Unilateral Cerebral Palsy: An Economic Evaluation of a Randomized Controlled Trial.

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 273 ( 95 107 to 945 ) f o r P a i n a n d I m p a c t o f D i s a b i l i t y , 1071 (95% UI: - 5718 t o 4606) for Family Health and 1732 ( 95 6448 to 8775 ) f o r A c c e s s t o S e r v i c e s . F o r t h e 4 r e m a i n i n g d o m a i n s , t h e i n t e r v e n t i o n w a s d o m i n a t e d b y s t a n d a r d c a r e . A t a w i l l i n g n e s s - t o - p a y t h r e s h o l d o f 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.