The association between neurodevelopmental disability and economic outcomes during mid-childhood

Background 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. Methods 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. Results Mean health and social service costs over the 12-month period were estimated at 577 pound [standard error (SE): 141] pound among children without neurodevelopmental impairment, 831 pound (112) pound among children with a mild neurodevelopmental impairment, 1053 pound (176) pound among children with a moderate neurodevelopmental impairment and 1662 pound (316) pound among children with a severe neurodevelopmental impairment. Mean health and social service costs were estimated at 1223 pound (157) pound and 695 pound (92) pound 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 pound (95% CI: 86 pound, 707; pound P= 0.012), 655 pound (95% CI: 167 pound, 1144; pound P= 0.009) and 1065 pound (95% CI: 113 pound, 2243; pound 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). Conclusions 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.