Measuring, valuing and including forgone childhood education and leisure time costs in economic evaluation: Methods, challenges and the way forward

Andronis, Lazaros; Maredza, Mandy; Petrou, Stavros

doi:10.1016/j.socscimed.2019.112475

Cited by 15 publications

(14 citation statements)

References 58 publications

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“…In addition, there are a number of methodological challenges in assigning costs to days of missed schooling, with no clear consensus on the most appropriate approach. 39 We costed the time taken off school based on calculating an average cost spent per pupil per day, based on the Annual Report on Education Spending in England. 24 This may underestimate the economic consequences of forgone leisure time and educational achievement.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial

et al. 2021

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ObjectiveThe aim of this economic evaluation was to assess whether home management could represent a cost-effective strategy in the patient pathway of type 1 diabetes (T1D). This is based on the Delivering Early Care In Diabetes Evaluation trial (ISRCTN78114042), which compared home versus hospital management from diagnosis in childhood diabetes and found no statistically significant difference in glycaemic control at 24 months.DesignCost-effectiveness analysis alongside a randomised controlled trial.SettingEight paediatric diabetes centres in England, Wales and Northern Ireland.Participants203 clinically well children aged under 17 years, with newly diagnosed T1D and their carers.Outcome measuresThe base-case analysis adopted n National Health Service (NHS) perspective. A scenario analysis assessed costs from a broader societal perspective. The incremental cost-effectiveness ratio (ICER), expressed as cost per mmol/mol reduction in glycated haemoglobin (HbA1c), was based on the mean difference in costs between the home and hospital groups, divided by mean differences in effectiveness (HbA1c). Uncertainty was considered in terms of the probability of cost-effectiveness.ResultsAt 24 months postintervention, the base-case analysis showed a difference in costs between home and hospital, in favour of home management (mean difference −£2,217; 95% CI −£2825 to −£1,609; p<0.001). Home care dominated, with an ICER of £7434 (saved) per mmol/mol reduction of HbA1c. The results of the scenario analysis also favoured home management. The greatest driver of cost differences was hospitalisation during the initiation period.ConclusionsHome management from diagnosis of children with T1D who are medically stable represents a less costly approach for the NHS in the UK, without impacting clinical effectiveness.Trial registration numberISRCTN78114042.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial

et al. 2021

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“…Inclusion of participant time costs in sensitivity analysis used average female earnings plus salary on‐costs, in lieu of a more robust way of capturing the opportunity cost of mother's time in the published literature. Whilst study participants from all trials were generally mothers who were not in the workforce during at least the initial phases of the intervention there is still an opportunity cost attached to their time, and so this analysis was undertaken to reflect the potential magnitude of benefits foregone had participants used their time in another way 48 .…”

Section: Discussionmentioning

confidence: 99%

Cost comparison of five Australasian obesity prevention interventions for children aged from birth to two years

et al. 2020

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Summary Background In the absence of rigorous evidence of cost‐effectiveness for early childhood obesity prevention interventions, the next‐best option may be for decision‐makers to consider the relevant costs of interventions when allocating resources. Objectives This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0‐2 years, undertaken in research settings in Australia and New Zealand. Methods A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro‐costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates. Results Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95% UI $77‐$82) to $1135 for the Healthy Beginnings intervention (95% UI $1059‐$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies. Conclusions An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS‐based intervention had the lowest delivery cost in this study.

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“…In addition, the costs mentioned most frequently were opportunity rather than financial costs. Currently the opportunity cost of children's time is neglected in economic evaluations [31], but it appears that this should be an important consideration from the schools' perspective. This might also explain why economic evidence does not reach school decision makers, with it seen as unsuitable to inform any changes in practice.…”

Section: Discussionmentioning

confidence: 99%

Use of Economic Evidence When Prioritising Public Health Interventions in Schools: A Qualitative Study with School Staff

Breheny

Frew

Williams

et al. 2020

IJERPH

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Schools are an ideal setting to deliver public health interventions, yet there are competing obligations that could limit their implementation. This study aimed to examine the decision making process and explore what evidence informs prioritisation of public health interventions in this setting. Semi-structured interviews were conducted with 14 staff in seven UK schools between November 2017 and March 2018. Participants were recruited from schools participating in The Birmingham Daily Mile trial and comprised leadership staff, teachers, and pastoral staff. Analyses used a constant comparison approach to explore the prioritisation process and schools’ use of economic evidence. Teachers felt that they had little decision making influence in regard to public health interventions, with this falling on leadership staff. Participants perceived tension between delivering academic subjects and public health initiatives and thought proven impact was important to justify the opportunity cost. Evidence did not appear to be routinely used, and participants were unaware of cost-effectiveness analyses, but thought it could be a useful tool. This study shows that schools face challenges in balancing the academic, health, and wellbeing needs of children. There is a need for targeted evidence that includes appropriate costs and outcomes and meets school decision makers’ needs.

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Measuring, valuing and including forgone childhood education and leisure time costs in economic evaluation: Methods, challenges and the way forward

Cited by 15 publications

References 58 publications

Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial

Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial

Cost comparison of five Australasian obesity prevention interventions for children aged from birth to two years

Use of Economic Evidence When Prioritising Public Health Interventions in Schools: A Qualitative Study with School Staff

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