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Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging:
John Jacob1,2,3, Chelsea Stunden4,5, Dhayanand Deenadayalan5,6
1Department of Pediatrics, Faculty of Medicine, University of British Columbia, 2D19-4480, Oak Street, Vancouver, BC, V6H 3V4, Canada. john.jacob@ubc.ca.
Insights
Virtual reality (VR) preparation for pediatric MRI is as effective as certified Child Life Programs (CLP) in managing anxiety and improving patient experience. VR-MRI can significantly reduce overall costs for patients and hospitals.
Area of Science:
- Pediatric healthcare economics
- Medical imaging preparation
- Virtual reality applications in medicine
Background:
- Effective preparation is crucial for pediatric patients undergoing hospital procedures like non-sedated medical imaging.
- Assessing the costs and consequences of different preparation methods is clinically important.
Purpose of the Study:
- To compare the costs and consequences of virtual reality magnetic resonance imaging (VR-MRI) preparation versus a certified Child Life Program (CLP) for pediatric patients.
- To evaluate health-related and non-health-related outcomes of both preparation methods.
Main Methods:
- A cost-consequence analysis (CCA) from a societal perspective in Canada was conducted.
- Data from a prior randomized clinical trial comparing VR and CLP in a simulated setting was utilized.
- The evaluation included health effects (anxiety, safety) and non-health effects (preparation time, user experience, costs).
Main Results:
- VR-MRI and CLP demonstrated similar benefits in managing anxiety, safety, and enabling non-sedated imaging.
- CLP was favored for preparation time and patient adaptation, while VR-MRI excelled in reducing displaced time and administrative burden.
- Total costs per patient for CLP ranged from CAN$315.16 to CAN$3843.41, whereas VR-MRI ranged from CAN$178.30 to CAN$283.85, with potential savings of CAN$119.01 to CAN$3364.62 per patient when VR-MRI replaced travel for CLP.
Conclusions:
- VR-MRI can increase access to quality preparation for children unable to attend onsite CLP.
- Utilizing VR-MRI where clinically appropriate can decrease overall costs for patients, hospitals, and society.
- The CCA provides decision-makers with a cost-benefit analysis to inform the integration of VR and CLP programs for pediatric MRI patients.
Introduction:
Effective preparation of children for hospital procedures, including non-sedated medical imaging, is an important clinical issue. This study aimed to assess the costs and consequences (effects) of preparing pediatric patients using two methods of delivering preparation for a scheduled magnetic resonance image (MRI)-virtual reality (VR-MRI) and a certified Child Life Program (CLP).
Methods:
A cost-consequence analysis (CCA) was performed using a societal perspective in Canada. The CCA catalogs a wide range of costs and consequences of VR-MRI compared with a CLP. The evaluation uses data from a prior randomized clinical trial evaluating VR and a CLP in a simulated trial. The economic evaluation encompassed health-related effects, including anxiety, safety and adverse events, and non-health effects, including preparation time, displaced time from usual activities, workload capacity, patient-specific adaptation, administrative burden, and user-experience metrics. The costs have been categorized into hospital operational costs, travel costs, other patient costs, and societal costs.
Results:
VR-MRI has similar benefits to the CLP in managing anxiety, safety and adverse events, as well as converting patients to non-sedated medical imaging. Preparation time and patient-specific adaptation are in favor of the CLP, while displaced time from usual activities, potential workload capacity, and administrative burden are in favor of VR-MRI. Both programs rank favorably in terms of user experience. The hospital operational costs ranged in Canadian dollars (CAN$) from CAN$32.07 for the CLP to between CAN$107.37 and CAN$129.73 for VR-MRI. Travel costs ranged from CAN$50.58 to CAN$2365.18 depending on travel distance for the CLP, and CAN$0 for VR-MRI. Other patient costs involved caregiver time off, and ranged from CAN$190.69 to CAN$$1144.16 for the CLP and CAN$47.67 for VR-MRI. The total cost for the CLP ranged from CAN$315.16 (CAN$277.91-$426.64) to CAN$3843.41 (CAN$3196.59-$4849.91) per patient depending on travel distance and amount of administrative support required, while VR-MRI preparation ranged from CAN$178.30 (CAN$178.20-$188.76) to CAN$283.85 (CAN$283.71-$298.40) per patient. For every instance where patient travel to visit a Certified Child Life Specialist (CCLS) onsite was replaced with VR-MRI, between CAN$119.01 and CAN$3364.62 total costs could be saved per patient.
Conclusions:
While it is neither feasible nor appropriate to replace all preparation with VR, using VR to reach children who cannot otherwise visit the CLP onsite could increase access to quality preparation, and using VR in place of the CLP where clinically indicated could reduce the overall costs for patients, the hospital, and society. Our CCA gives decision makers a cost analysis and the relevant effects of each preparation program so they can value the VR and CLP programs more broadly within the potential health and non-health outcomes of pediatric patients scheduled for MRI at their facilities.
