Background: Many autistic children experience difficulties in their communication and language skills development, with consequences for ’social development into adulthood, often resulting in challenges over the life-course and high economic impacts for individuals, families and society. The PACT (Preschool-Autism-Communication-Trial) intervention is effective in terms of improved social communication and some secondary outcomes. A previously published within-trial economic analysis found that results at 13 months did not support its cost-effectiveness. We modelled cost-effectiveness over 6 years and across four European countries. Methods: Using simulation modelling, we built on economic analyses in the original trial, exploring longer-term cost-effectiveness at 6 years (in England). We adapted our model to undertake an economic analysis of PACT in Ireland, Italy and Spain. Data on resource use were taken from the original trial and a more recent Irish observational study. Results: PACT is cost-saving over time from a societal perspective, even though we confirmed that, at 13 months post-delivery, PACT is more expensive than usual treatment (across all countries) when given to preschool autistic children. After 6 years, we found that PACT has lower costs than usual treatment in terms of unpaid care provided by parents (in all countries). Also, if we consider only out-of-pocket expenses from an Irish study, PACT costs less than usual treatment. Discussion: PACT may be recommended as a cost-saving early intervention for families with an autistic child
