Economic evaluation of the Akwenda Intervention Program for children and young people with cerebral palsy in rural Uganda: A trial-based analysis of costs and outcomes.

Abstract

Aim: To relate the trial-based costs of the Akwenda Intervention Program, a multi-component, community-based intervention for children and young people with cerebral palsy (CP) in rural Uganda, to multiple prespecified child and caregiver outcomes.

Method: An economic evaluation was conducted within a cluster-randomized, assessor-blinded trial of 94 participants with CP (aged 2-23 years; 42 females) and their caregivers, allocated to intervention or usual care. Programme delivery costs were assessed from a restricted health care or provider perspective; selected out-of-pocket costs incurred by participating families were reported separately over 12 months. Outcome-specific incremental cost-effectiveness ratios (ICERs) were estimated for child outcomes (66-item Gross Motor Function Measure, Pediatric Evaluation of Disability Inventory [Ugandan version], and Picture My Participation) and caregiver outcomes (Zimbabwe Caregiver Challenges Scale and Pediatric Quality of Life Inventory Family Impact Module). Uncertainty was assessed using bootstrapping, cost-effectiveness planes, and exploratory acceptability curves. Costs were also determined per minimal clinically important difference (MCID) gained.

Results: The mean incremental cost per child was US$1069 to US$1075. Outcome-specific ICERs ranged from US$26 to US$352 per unit of improvement for 10 of 11 outcomes; the Pediatric Evaluation of Disability Inventory (Ugandan version) mobility had a higher and highly uncertain ICER. Costs per MCID gained ranged from US$230 to US$600. Acceptability analyses were presented as exploratory uncertainty analyses because no established Uganda-specific willingness-to-pay thresholds exist for these outcome measures.

Interpretation: The Akwenda Intervention Program improved child functioning, participation, and caregiver well-being at additional but predictable costs. This trial-based economic evaluation quantifies the costs associated with improvement across multiple prespecified outcomes and provides economic information relevant to the implementation of community-based rehabilitation in low-resource settings.