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

Abstract

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition significantly impacting children and families through communication and social interaction deficits. While early speech-language intervention demonstrates effectiveness for children with ASD, limited research exists comparing cost-effectiveness across public and private healthcare sectors, particularly in developing countries like Pakistan.

Methods: This cross-sectional comparative study analyzed 256 participants (128 per sector) consisting of parents of children with ASD aged 2-6 years receiving speech-language therapies in Karachi, Pakistan. Data collection utilized demographic questionnaires, validated clinical assessments (CARS-2, PLS-5, VABS-3), cost assessment instruments, and quality of life measures. Statistical analyses included descriptive statistics, comparative analyses, and economic evaluations using cost-effectiveness and cost-benefit frameworks.

Results: Significant intersectoral differences emerged across demographic, clinical, and economic variables. Private sector families demonstrated higher socioeconomic status (71.9% earning >PKR 75,000 versus 10.2% public sector) and achieved superior clinical outcomes, with children showing 12.8-point higher language scores and 11.3-point socialization improvements. Despite higher annual costs (PKR 198,450 versus PKR 89,340), private services demonstrated superior cost-effectiveness with better benefit-cost ratios (2.12 versus 1.84) and shorter payback periods (2.8 versus 3.2 years).

Conclusions: Early speech-language intervention generates substantial benefits across both sectors, with private services achieving superior clinical outcomes and long-term cost-effectiveness despite higher initial investments. Findings support increased public sector investment and policy interventions to enhance service quality while addressing socioeconomic disparities in autism intervention access.