Cost-effectiveness of cognitive-behavioral therapy versus treatment as usual for anxiety disorders in children with autism spectrum disorder

•CBT had a high probability to be more effective compared to TAU.•The probability that either CBT or TAU is more costly did not differ much.•CBT seems a cost-effective intervention to treat anxiety disorders in ASD.

The study's aim was to evaluate the cost-effectiveness of CBT compared to treatment as usual (TAU). In total, 49 children aged 8–18 years with ASD and comorbid anxiety disorders, and their parents, participated; 24 were assigned to CBT and 25 were assigned to TAU. Outcome measures were the percentage of children free from their primary anxiety disorder and quality adjusted life years (QALYs). Costs were measured using a retrospective cost-questionnaire. Effects and costs were assessed at pre-, post-, and three months after treatment. Effects and costs were not statistically different between CBT and TAU, however the incremental cost-effectiveness ratio (ICER) demonstrated that CBT dominates TAU. Bootstrapped ICERs demonstrated that CBT has a high probability to be more effective than TAU, however, the probability that either CBT or TAU is more costly did not differ much. Secondary analyses demonstrated fairly robust results. CBT seems a cost-effective intervention compared to TAU, however, long-term follow-ups and comparisons between CBT and specific TAUs are necessary. Cost-effectiveness analyses may help inform policy makers to decide how to treat anxiety disorders in children with ASD.