Kitschen Anne, Asegu Lulseged M, Sauerland Dirk
Chair for Institutional Economics and Health Policy, Department of Philosophy, Politics and Economics, Witten/Herdecke University, Witten, Germany.
BMC Pediatr. 2025 Jan 29;25(1):73. doi: 10.1186/s12887-024-05384-9.
In children and adolescents, the prevalence of chronic diseases, e.g., obesity, asthma, and attention-deficit/hyperactivity disorder (ADHD), has increased in the last decades. These diseases have negative effects on patients and their families and pose a significant economic burden. Indirect costs related to caregivers' lost workdays or children's and adolescents' missed education are likely to be high. However, there are no guidelines for measuring and valuing indirect costs in this population. Thus, this scoping review aims to examine methods in published articles, compare these approaches, and analyze benefits and shortcomings.
The systematic literature search was conducted in Medline, PsycINFO, Embase, NHS EED, and the HTA Database considering all articles from inception until 16 October 2024. Two researchers independently screened title, abstract, and full text. Cost-of-illness studies (COIs) reporting indirect costs for obesity, asthma, or attention-deficit/hyperactivity disorders (ADHD) in children and adolescents up to 24 years were included. Only studies published in English or German were considered. Methodological characteristics, measurement of indirect costs, cost components, data source, and costing methods were extracted.
The literature search revealed 45 studies. Thirty-two articles on asthma, eight on ADHD, and five on obesity were included. While all studies included absenteeism, only a few assessed and valued unpaid work (31.1%) or presenteeism (13.3%). Overall, 88.9% of the studies considered indirect costs for caregivers. Additionally, 51.1% considered productivity losses for children and adolescents, with 47.8% of these studies assigning a monetary value to these losses. The largest share of studies (53.3%) considered indirect costs by measuring and valuing caregivers' lost work time.
In conclusion, various methodologies were used to consider indirect costs for chronic diseases in children and adolescents, underlining the need for standardization. This scoping review presents methodologies for incorporating indirect costs in COIs and other types of economic evaluations, which focus on children and adolescents and adopt a societal perspective. These indirect costs include both paid and unpaid activities, as well as absenteeism and presenteeism, not only for caregivers but also for children and adolescents themselves.
在儿童和青少年中，慢性病（如肥胖症、哮喘和注意力缺陷多动障碍（ADHD））的患病率在过去几十年中有所上升。这些疾病对患者及其家庭产生负面影响，并带来巨大的经济负担。与照顾者工作日损失或儿童及青少年缺课相关的间接成本可能很高。然而，目前尚无针对该人群间接成本测量和估值的指南。因此，本范围综述旨在研究已发表文章中的方法，比较这些方法，并分析其优缺点。
在Medline、PsycINFO、Embase、NHS EED和HTA数据库中进行系统文献检索，纳入从数据库建立至2024年10月16日的所有文章。两名研究人员独立筛选标题、摘要和全文。纳入报告24岁及以下儿童和青少年肥胖症、哮喘或注意力缺陷多动障碍（ADHD）间接成本的疾病成本研究（COI）。仅考虑以英文或德文发表的研究。提取方法学特征、间接成本测量、成本构成、数据来源和成本核算方法。
文献检索共发现45项研究。其中包括32篇关于哮喘的文章、8篇关于ADHD的文章和5篇关于肥胖症的文章。虽然所有研究都纳入了缺勤情况，但只有少数研究评估并估值了无薪工作（31.1%）或出勤主义（13.3%）。总体而言，88.9%的研究考虑了照顾者的间接成本。此外，51.1%的研究考虑了儿童和青少年的生产力损失，其中47.8%的研究为这些损失赋予了货币价值。最大比例的研究（53.3%）通过测量和估值照顾者的工作时间损失来考虑间接成本。
总之，在考虑儿童和青少年慢性病间接成本时使用了各种方法，这凸显了标准化的必要性。本范围综述介绍了将间接成本纳入疾病成本研究及其他类型经济评估的方法，这些评估关注儿童和青少年，并采用社会视角。这些间接成本包括有偿和无偿活动，以及缺勤和出勤主义，不仅涉及照顾者，也涉及儿童和青少年自身。
