Cost-benefit Analysis of Early Speech-Language Intervention in Children with Autism Spectrum Disorder: A Public vs. Private Sector Perspective in Pakistan

Background: This study examines the cost-benefit analysis of early speech-language intervention for children with autism spectrum disorder (ASD) across public and private healthcare sectors in Pakistan, addressing the gap in comparative cost-effectiveness research within developing country contexts.Methods: A cross-sectional comparative design included 256 participants (128 per sector) from Karachi, Pakistan, targeting parents of children with ASD aged 2-6 years receiving speech-language therapy.Data collection utilized demographic questionnaires, validated clinical assessments (CARS-2, PLS-5, VABS-3), comprehensive cost instruments measuring direct and indirect expenses, and quality of life measures.Economic evaluations employed cost-effectiveness and cost-benefit analysis frameworks.Results: Private sector families demonstrated substantially higher socioeconomic status (71.9% earning >PKR 75,000 monthly versus 10.2% public sector).Children in private settings achieved superior outcomes: 12.8-point higher language scores and 11.3-point socialization improvements.Despite higher annual costs (PKR 198,450 versus PKR 89,340), private sector services showed better cost-effectiveness with superior benefit-cost ratios (2.12 versus 1.84), higher quality-adjusted life years (0.78 versus 0.62 QALYs), and shorter payback periods (2.8 versus 3.2 years). Conclusion:This provides Pakistan's first comprehensive cost-benefit analysis of early speech-language intervention for ASD children comparing healthcare sectors, offering empirical evidence demonstrating substantial investment returns while revealing critical socioeconomic access disparities.