Problematic cost–utility analysis of interventions for behavior problems in children and adolescents

Abstract

Cost-utility analyses are slowly becoming part of randomized control trials evaluating physical and mental health treatments and (preventive) interventions in child and adolescent development. The British National Institute of Health and Care Excellence, for example, insists on the use of gains in Quality Adjusted Life Years (QALYs) to compute the "value for money" of interventions. But what counts as a gain in quality of life? For one of the most widely used instruments, the EuroQol 5 Dimensions scale (EQ-5D), QALYs are estimated by healthy individuals who provide utility scores for specific health states, assuming that the best life is a life without self-experienced problems in five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The worst imaginable outcome is defined as "a lot of problems" in each of these five domains. The impact of the individual's problems on the social network is not weighted, and important social-developmental domains (externalizing problems, social competence) are missing. Current costutility computations based on EQ-5D favor physical health over mental health, and they rely on adult weights for child and adolescent quality of life. Thus, a level playing field is absent, and developmental expertise is sorely missing. K E Y W O R D S cost-utility analysis, interventions, children, mental health, Quality Adjusted Life-Years (QALY), EuroQol 5 Dimensions scale (EQ-5D), critical review This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Outcome measures for economic evaluations and cost‐effectiveness analyses of interventions for people with intellectual disabilities: A methodological systematic review

“…The problems with adopting the EQ‐5D extend to the general literature on mental healthcare interventions. For example, according to van Ijzendoorn and Bakermans‐Kranenburg (2020), the dimensions included in the EQ‐5D seem to focus more on physical rather than mental health, which may cause discrimination (Crisp, 1991). Dimensions referring to outward behaviour (e.g., aggressive behaviour) and social relationships appear to be neglected (Chisholm et al, 1997; van Ijzendoorn & Bakermans‐Kranenburg, 2020).…”

“…In general, the ways utility values are elicited to evaluate mental healthcare interventions is fraught with difficulties, particularly considering that the general population, from whom utility values are normally elicited, may have different perceptions of, and exposure to, the impacts of mental impairments compared with those actually affected (Brazier, 2008; Chisholm et al, 1997; van Ijzendoorn & Bakermans‐Kranenburg, 2020). As explained by Lamsal and Zwicker (2017), adopting traditional techniques which elicit utility values for use in economic evaluations, like the standard gamble and the time trade‐off, may also be problematic when administered to children with NDDs (including those with intellectual disabilities) who may struggle to understand time‐related choices between different health states.…”

“…Finally, by being at the age of development, children and adolescents have different and more dynamic preferences, which change over time. For them, social integration is a bigger predictor of quality of life, when compared with adults (van Ijzendoorn & Bakermans‐Kranenburg, 2020).…”

A good investment: longer‐term cost savings of sensitive parenting in childhood

“…The study had a number of strengths, including a reasonably large sample size for such labour‐intensive methods, a prospective longitudinal design, ‘gold standard’ direct observation of parenting and broad consideration of confounders, including family‐ and individual‐level risks. It included a number of important drivers of costs that are typically left out of quality‐of‐life and economic analyses, such as antisocial behaviour and attachment status (see van IJzendoorn and Bakermans‐Kranenburg (2020).…”

Cost-effectiveness Analysis of the Dental RECUR Pragmatic Randomized Controlled Trial: Evaluating a Goal-oriented Talking Intervention to Prevent Reoccurrence of Dental Caries in Children

“…This dataset had no QALY values because at the time the study was conducted there was no preference-based measure of utility for young children. Since then, the CHU-9D has been developed and is increasingly being used in children aged ≥ 7 years [44]; hence, values from published literature were applied to this study. Although publications have shown the positive trends between dental caries and otitis media [45], QALY values from the DR-BNI trial might have varied slightly.…”