Healthcare utilisation and costs associated with poor access to diagnosis and treatment for children and young people with tic disorders

Abstract

BACKGROUND: There are no specific national guidelines in England to guide healthcare professionals in how to assess or treat young people with tic disorders. Access to evidence-based treatment, including behavioural therapy, is of limited availability. OBJECTIVES: This study examined the economic impact on services arising from a lack of access to appropriate healthcare services for young people with tic disorders, alongside the impact on school attendance. METHODS: This study used data from the randomised controlled trial 'ORBIT' (Online Remote Behavioural Intervention for Tics). ORBIT compared online exposure and response prevention behavioural therapy for tics with online psychoeducation and recruited 224 young people aged 9-17 years in England. Here, we explore costs of health service use and school absenteeism from children who participated in the ORBIT trial and present these alongside the economic impact of including ORBIT within a tic service. We supplement ORBIT data with findings from two case studies. FINDINGS: The data showed that patients have care from several healthcare professionals and miss school due to accessing care for tics. The case studies suggest that most of these contacts with specialist services are unlikely to be supportive. However, adding ORBIT could save the National Health Service £1 million. CONCLUSIONS: Young people with tic disorders are likely to engage in substantial use of healthcare resources because of inadequate care pathways. The availability of an evidence-based online therapy such as ORBIT could save money to the healthcare system. CLINICAL IMPLICATIONS: There is a need to improve service provision and develop national guidelines for tic disorders. TRIAL REGISTRATION NUMBER: ISRCTN70758207, NCT03483493.