Primary prevention of pediatric abusive head trauma: a cost audit and cost-utility analysis
Joshua Friedman1, Peter Reed, Peter Sharplin
1Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Private Bag 92024, Auckland 1142, New Zealand.
Insights
Pediatric abusive head trauma incurs substantial lifetime costs, averaging over $1 million per child. Investing in prevention programs offers a strong economic benefit, reducing overall societal expenses and improving child health outcomes.
Area of Science:
- Public Health
- Health Economics
- Pediatric Trauma
Background:
- Pediatric abusive head trauma (AHT) represents a significant public health issue with substantial associated costs.
- Understanding the direct financial burden of AHT is crucial for evaluating prevention strategies.
Purpose of the Study:
- To determine the comprehensive direct costs of pediatric abusive head trauma in New Zealand.
- To assess the cost-benefit of implementing a national primary prevention program for AHT.
Main Methods:
- A 5-year cohort study of infants with AHT in Auckland, New Zealand.
- Inclusion of direct costs from hospital care, rehabilitation, special education, child protection, criminal justice, and lifetime care.
- Cost-utility analysis for a national primary prevention program using established costs and incidence data.
Main Results:
- The total direct cost for 52 AHT cases was over $NZ52 million, averaging $NZ1,008,344 per child.
- Lifetime care costs for survivors with moderate to severe disabilities constituted the largest expense ($NZ33.6 million).
- Cost-utility analysis indicated a strong economic argument for primary prevention, with potential for net cost reduction and improved health outcomes.
Conclusions:
- Pediatric AHT is exceptionally costly, with acute hospitalization representing a small fraction of lifetime direct costs.
- Effective shaken baby prevention programs present a compelling economic case for implementation.
- This study provides essential data for future cost-benefit analyses in AHT prevention.
Objectives:
To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program.
Methods:
A 5 year cohort of infants with abusive head trauma admitted to hospital in Auckland, New Zealand was reviewed. We determined the direct costs of hospital care (from hospital and Ministry of Health financial records), community rehabilitation (from the Accident Compensation Corporation), special education (from the Ministry of Education), investigation and child protection (from the Police and Child Protective Services), criminal trials (from the Police, prosecution and defence), punishment of offenders (from the Department of Corrections) and life-time care for moderate or severe disability (from the Accident Compensation Corporation). Analysis of the possible cost-utility of a national primary prevention program was undertaken, using the costs established in our cohort, recent New Zealand national data on the incidence of pediatric abusive head trauma, international data on quality of life after head trauma, and published international literature on prevention programs.
Results:
There were 52 cases of abusive head trauma in the sample. Hospital costs totaled $NZ2,433,340, child protection $NZ1,560,123, police investigation $NZ1,842,237, criminal trials $NZ3,214,020, punishment of offenders $NZ4,411,852 and community rehabilitation $NZ2,895,848. Projected education costs for disabled survivors were $NZ2,452,148, and the cost of projected lifetime care was $NZ33,624,297. Total costs were $NZ52,433,864, averaging $NZ1,008,344 per child. Cost-utility analysis resulted in a strongly positive economic argument for primary prevention, with expected case scenarios showing lowered net costs with improved health outcomes.
Conclusions:
Pediatric abusive head trauma is very expensive, and on a conservative estimate the costs of acute hospitalization represent no more than 4% of lifetime direct costs. If shaken baby prevention programs are effective, there is likely to be a strong economic argument for their implementation. This study also provides robust data for future cost-benefit analysis in the field of abusive head trauma prevention.
