Measuring and Incorporating Family Spillover Cost and Health Consequences in Economic Evaluation of Child Health Interventions

Abstract

Background: A child's health conditions affect family members’ health, well-being, and economic well-being. However, these spillover effects are ignored in conventional economic evaluations, resulting in an incomplete understanding of the cost and consequences of child health interventions. Frameworks for including family spillover effects have been proposed but are not specific to pediatric economic evaluations.Objective: The primary aim was to develop a theoretical framework for incorporating family spillover effects in pediatric economic evaluation. Specific objectives were to (1) summarize methods used in pediatric cost-utility analyses (CUAs) to include family health spillover effects and maternal-perinatal CUAs to integrate health outcomes of pregnant women and children, (2) integrate evidence from theories, theoretical frameworks and models into a theoretical framework, and (3) measure health-related quality of life (HRQoL), care-related quality of life (QoL), mental health service use and time losses from paid labour and/or usual activities for parents of children with a neuroinflammatory disorder(s) (ND). Methods: A systematic review of the literature was conducted to determine methods used to incorporate health outcomes of family members in pediatric and maternal-perinatal CUAs. A critical interpretive synthesis was performed to develop a theoretical framework for incorporating family spillover effects in pediatric economic evaluation. Empiric data were collected prospectively from the Hospital for Sick Children in a cross-sectional study. Descriptive statistics were used to describe time lost from paid labour and/or usual activities, HRQoL, carer-related QoL and mental health services. Results: Considerable heterogeneity was observed in methods applied to incorporate health outcomes of family members in pediatric and maternal-perinatal CUAs. In the proposed theoretical framework ‘conducting economic evaluation from a pediatric family perspective,’ the family is a unit of analysis, where family costs and consequences related to a child's illness or disabilities are derived from all family members and incorporated into the analysis. Findings from the cross-sectional study indicated reduced HRQoL and carer-related QoL, and time lost from paid labour and/or usual activities of parents of children with ND. Conclusion: The thesis presents a theoretical framework ‘conducting economic evaluation from a family perspective’ for incorporating family spillover effects in pediatric CUAs. This can be used to develop empirical methods to include family spillover effects in pediatric CUAs.