Economic evaluation of caregiver interventions for children with developmental disabilities: a scoping review

Introduction

Globally, families with children with developmental disabilities (DDs) may experience several challenges, including social isolation, stigma, and poverty especially in low-income settings in Africa. Most children with DDs in Africa remain unidentified and receive no formal support. Caregiver interventions focusing on education and training for carers of children with DDs have been shown to be adaptable and low intensity in implementation. However, economic evaluation evidence on caregiver interventions for DD, which is important for effective resource allocation, is limited. This review aimed to describe the nature of evidence available and methodological aspects of economic evaluations for caregiver interventions for DDs.

Methods

This scoping review employed the Arksey and O’Malley framework and aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Seven electronic databases, grey literature and cited references were systematically searched to identify eligible studies on economic evaluations of caregiver interventions for children with DDs published in 1993-2023. We assessed the quality of the included studies using the Drummond checklist. Data were systematically extracted, tabulated, and qualitatively synthesised using inductive thematic analysis.

Results

The searches yielded 7811 articles. Seventeen studies all in high-income countries met the inclusion criteria which focused on caregiver interventions for autism spectrum disorder (n=7), attention deficit hyperactivity disorder (ADHD) (n=6), disruptive behaviour and behaviour problems with ADHD (n=5), intellectual disabilities (n=1) and language delay (n=1).

The most used economic evaluation approach was trial based models (n=14), followed by decision analytic models (n=5)). The methods were not explicitly stated in 1 study. Economic evaluation analyses included cost effectiveness (n=11), costing (n=3), cost utility (n=2), cost consequence (n=1) cost benefit (n=1), and combined analyses (n=2). Nine studies reported the interventions as cost effective, five studies reported the intervention to be cost saving, and one identified caregiver costs as a cost driver. The main identified methodological challenges were related to costing, outcome measurement in children and the appropriate time horizon for modelling.

Conclusion

Caregiver interventions demonstrate cost-effectiveness, with the available evidence supporting the adoption of the interventions evaluated. Caregiver interventions are a promising avenue to strengthen access and reduce costs associated with health services for children with DDs. Additionally, this review identified key methodological challenges and highlighted areas for further research to address these limitations. Prioritizing more economic evaluation studies in this area would inform decision-making on efficient resource allocation, promote inclusivity and equitable access to services for children with DDs.