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.