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Cost-effectiveness analysis and emergency medical services for children: issues and applications
1University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Center for Applied Research and Evaluation, Little Rock 72202-3591, USA. tilfordmickj@uams.edu
Insights
Cost-effectiveness analysis (CEA) for pediatric healthcare is limited. Challenges include measuring caregiver time and using quality-adjusted life years (QALYs) for young children, hindering research parity with adult healthcare.
Area of Science:
- Health Services Research
- Pediatric Economics
- Medical Decision Making
Background:
- Cost-effectiveness analysis (CEA) is crucial for evaluating healthcare interventions but is less developed for pediatric populations compared to adults.
- Existing frameworks, like those from the US Panel on Cost-effectiveness in Health and Medicine, present challenges when applied to children, particularly in emergency medical services.
- There's a significant gap in research assessing the cost-effectiveness of treatments and prevention strategies for children.
Purpose of the Study:
- To highlight specific challenges in conducting CEA for pediatric populations.
- To discuss the applicability of established CEA recommendations to children's healthcare.
- To identify key areas for future research in pediatric health economics, especially for emergency medical services.
Main Methods:
- The study reviews existing recommendations for CEA and analyzes their suitability for pediatric contexts.
- It specifically examines issues related to incorporating patient and caregiver time into cost measures.
- A critical assessment is made of using quality-adjusted life years (QALYs) as an outcome measure in pediatric CEA.
Main Results:
- Standard CEA methods face difficulties when applied to pediatric populations, particularly concerning time costs and outcome measures.
- The use of QALYs is problematic for young children due to the difficulty in developing applicable preference weights.
- Pediatric research in health services and emergency medical services lags behind adult research in cost-effectiveness evaluation.
Conclusions:
- Pediatric CEA requires adapted methodologies to accurately reflect costs and outcomes in child populations.
- Developing age-appropriate preference weights for QALYs is essential for advancing pediatric CEA.
- Addressing these methodological gaps is critical for improving child health services research and ensuring parity with adult healthcare research.
Abstract:
Studies to assess the cost-effectiveness of alternative treatment or prevention strategies for children are far fewer than those for adults. This article highlights specific issues relevant to the conduct of cost-effectiveness analysis (CEA) in pediatric populations following the recommendations of the US Panel on Cost-effectiveness in Health and Medicine and discusses CEA applications relevant to emergency medical services for children. The article addresses whether patient time should be included in measures of costs, whether caregiver time costs are included and measured properly, and most importantly, whether the study can use quality adjusted life years (QALYs) as an outcome measure. Pediatric researchers may be unable to follow the panel's recommendations for including QALYs as an outcome measure in CEA studies involving young children. Developing preference weights applicable to young children may be a productive field for pediatric researchers. Without such efforts, the field of child health services research in general and the field of emergency medical services for children in particular will continue to lag behind adult fields in assessing the costs and outcomes of the services they provide.