Petrou S, Johnson S, Wolke D, Marlow N
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, London, UK.
Child Care Health Dev. 2013 May;39(3):345-57. doi: 10.1111/j.1365-2214.2012.01368.x. Epub 2012 Feb 28.
There is a paucity of evidence on the association between childhood disability and economic outcomes. This study estimates the economic costs and health utilities associated with neurodevelopmental impairment or serious neurodevelopmental disability during the 11th year of life.
Standardized tests of cognitive ability and clinical assessments of functional abilities were performed on participants of a whole population study of extremely preterm children and term-born controls (EPICure). Profiles of children's use of health, social and education services, and descriptions of their health status using the Health Utilities Index Mark 2 and Mark 3 health status classification systems, were extracted from detailed questionnaires completed by the main parent. Descriptive and multiple regression techniques were used to explore the association between neurodevelopmental impairment or serious neurodevelopmental disability and two sets of economic outcomes; economic costs and health utilities.
Mean health and social service costs over the 12-month period were estimated at £577 [standard error (SE): £141] among children without neurodevelopmental impairment, £831 (£112) among children with a mild neurodevelopmental impairment, £1053 (£176) among children with a moderate neurodevelopmental impairment and £1662 (£316) among children with a severe neurodevelopmental impairment. Mean health and social service costs were estimated at £1223 (£157) and £695 (£92) among children with and without serious neurodevelopmental disability, respectively. After controlling for clinical and sociodemographic confounders, mild, moderate and severe neurodevelopment impairment increased health and social service costs by an average of £397 (95% CI: £86, £707; P= 0.012), £655 (95% CI: £167, £1144; P= 0.009) and £1065 (95% CI: -£113, £2243; P= 0.076), respectively. Cost differences were accentuated when broader public sector costs were considered. The mean (SE) Health Utilities Index Mark 3 multi-attribute utility score for the children with neurodevelopmental disability was 0.652 (0.039), compared with 0.923 (0.009) for children without neurodevelopmental disability, generating a mean difference in utility score of 0.272 (95% CI: 0.220, 0.323) that was statistically significant (P < 0.001).
Our data should act as a significant new resource for economic analysts modelling the overall economic impact of childhood neurodevelopment impairment or disability or the cost-effectiveness of interventions targeted at neurodevelopmentally impaired or disabled children.
关于儿童残疾与经济结果之间关联的证据匮乏。本研究估算了生命第11年时与神经发育障碍或严重神经发育残疾相关的经济成本和健康效用。
对一组极早产儿和足月儿对照的全人群研究（EPICure）的参与者进行了认知能力标准化测试和功能能力临床评估。从主要家长填写的详细问卷中提取了儿童使用健康、社会和教育服务的情况简介，以及使用健康效用指数2级和3级健康状况分类系统对其健康状况的描述。采用描述性和多元回归技术探讨神经发育障碍或严重神经发育残疾与两组经济结果之间的关联；经济成本和健康效用。
在无神经发育障碍的儿童中，估计12个月期间的平均健康和社会服务成本为577英镑[标准误（SE）：141英镑]，轻度神经发育障碍儿童为831英镑（112英镑），中度神经发育障碍儿童为1053英镑（176英镑），重度神经发育障碍儿童为1662英镑（316英镑）。有严重神经发育残疾和无严重神经发育残疾的儿童的平均健康和社会服务成本估计分别为1223英镑（157英镑）和695英镑（92英镑）。在控制了临床和社会人口学混杂因素后，轻度、中度和重度神经发育障碍使健康和社会服务成本平均分别增加397英镑（95%CI：86英镑，707英镑；P = 0.012）、655英镑（95%CI：167英镑，1144英镑；P = 0.009）和1065英镑（95%CI：-113英镑，2243英镑；P = 0.076）。当考虑更广泛的公共部门成本时，成本差异更加明显。神经发育残疾儿童的平均（SE）健康效用指数3级多属性效用评分为0.652（0.039），无神经发育残疾儿童为0.923（0.009），效用评分平均差异为0.272（95%CI：0.220，0.323），具有统计学显著性（P < 0.001）。
我们的数据应为经济分析师提供重要的新资源，用于模拟儿童神经发育障碍或残疾的总体经济影响，或针对神经发育受损或残疾儿童的干预措施的成本效益。
