Priority setting in early childhood development: an analytical framework for economic evaluation of interventions

Abstract

BackgroundEarly childhood development (ECD) sets the foundation for healthy and successful lives with important ramifications for education, labour market outcomes and other domains of well-being. Even though a large number of interventions that promote ECD have been implemented and evaluated globally, there is currently no standardised framework that allows a comparison of the relative cost-effectiveness of these interventions.MethodsWe first reviewed the existing literature to document the main approaches that have been used to assess the relative effectiveness of interventions that promote ECD, including early parenting and at-home psychosocial stimulation interventions. We then present an economic evaluation framework that builds on these reviewed approaches and focuses on the immediate impact of interventions on motor, cognitive, language and socioemotional skills. Last, we apply our framework to compute the relative cost-effectiveness of interventions for which recent effectiveness and costing data were published. For this last part, we relied on a recently published review to obtain effect sizes documented in a consistent manner across interventions.FindingsOur framework enables direct value-for-money comparison of interventions across settings. Cost-effectiveness estimates, expressed in $ per units of improvement in ECD outcomes, vary greatly across interventions. Given that estimated costs vary by orders of magnitude across interventions while impacts are relatively similar, cost-effectiveness rankings are dominated by implementation costs and the interventions with higher value for money are generally those with a lower implementation cost (eg, psychosocial interventions involving limited staff).ConclusionsWith increasing attention and investment into ECD programmes, consistent assessments of the relative cost-effectiveness of available interventions are urgently needed. This paper presents a unified analytical framework to address this need and highlights the rather remarkable range in both costs and cost-effectiveness across currently available intervention strategies.

A meta‐analytic review of the implementation characteristics in parenting interventions to promote early child development

“…49 A group of authors recently developed an economic evaluation framework that enabled direct value-for-money comparisons of 12 parenting interventions (11 of which met inclusion criteria for this review) across settings and found significant variation in incremental cost-effectiveness ratios, ranging from $US 29 to $US 5063 per standard deviation increase in ECD (cognitive, language, motor, and socioemotional) outcomes. 50 Similar to our review, Verguet and colleagues' analysis was limited by a scarcity of costing data across studies. There is clearly a need for more comprehensive and standardized collection of costing data-both in the short-and long-term-to better understand the economic impacts and benefits of investing in interventions to promote ECD.…”

“…Specifically, interventions need to report two key pieces of information: (1) the cost of implementing the intervention, so as to inform efforts to scale up delivery and (2) the cost‐effectiveness of the intervention, to determine how much financial investment is needed to achieve significant impacts on child and caregiver outcomes 49 . A group of authors recently developed an economic evaluation framework that enabled direct value‐for‐money comparisons of 12 parenting interventions (11 of which met inclusion criteria for this review) across settings and found significant variation in incremental cost‐effectiveness ratios, ranging from $US 29 to $US 5063 per standard deviation increase in ECD (cognitive, language, motor, and socioemotional) outcomes 50 . Similar to our review, Verguet and colleagues’ analysis was limited by a scarcity of costing data across studies.…”

Measuring the cost-effectiveness of a home-visiting intervention to promote early child development among rural families linked to the Rwandan social protection system

“…There have, however, been encouraging results which suggest that lower intensity, and therefore more affordable, interventions, done by non-specialists, can still be effective [ 17 ]. To add to this literature we need to test, cost, and compare lower intensity interventions provided across a range of contexts [ 18 ]. Despite this need, home-visiting interventions are seldom subject to cost-analysis, even more so for interventions in LMICs or that address broader features of the home environment such as family functioning and reduction of violence [ 19 , 20 ].…”

“…The data that are available on the costs of programmes suggests that the resource intensity of ECD interventions varies greatly. Using a standadised costing approach, Verguet et al estimated the cost of home and group based programmes targetting children 0–3 years ranged from $18 to $3,519 [ 18 ]. It is clear, therefore, that there is substantial variation in the resource intensity of interventions.…”

“…Composite outcome measures such as Disability Adjusted Life Years or Quality Adjusted Life Years have been used to address this problem in health care by converting multiple health outcomes into a common unit. They are, however, inadequate here as they include only health benefits and home-visiting interventions for ECD have impacts beyond health [ 18 ]. Given these challenges, CBA has at times been preferred to CEA as it allows multiple outcomes to be included in the analysis as long as they are measured in or can be converted to a money metric.…”