Systematic review of the economic impact of cerebral palsy

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Abstract

Background

Cerebral palsy (CP) and its associated conditions can pose a significant economic burden on families, the health care system and the general economy. The boundary for inclusion of costs in research can vary substantially across studies.

Aims

To summarize the evidence for burden of disease for CP including the impacts on the health system, the community and carers.

Methods

Literature was identified from Ovid Medline, Embase, CINHAL, PsyInfo, Econlit, Health Economic Evaluation Database (HEED) and NHS Economic Evaluation Database (NHS EED) in the Cochrane Library. The search was restricted to articles published in English between 1970 and April 2016. All costs were converted to $USD 2016 price.

Results

Twenty-two articles were included. Studies varied from snapshot cost descriptions to more complex lifetime estimates, from prevalence-based to incidence-based studies, and from inclusion to exclusion of non-medical costs. There was a strong positive relationship between CP severity and expenditure. Significant costs were incurred by families and the welfare system to facilitate school and community engagement.

Conclusion

Facilitating participation for people with CP involves substantial expense. The size, nature and distribution of the economic burden emphasises the importance of finding effective strategies to reduce the risk and severity of CP, together with how it is financed.

Section snippets

What does this paper add?

This review systematically documents and summarises the economic impacts of CP from literature that employed different analysis techniques, cost components, and settings. This review showed that there was a strong positive relationship between CP severity and expenditure. Significant costs were borne by families and the welfare system to facilitate school and community engagement. Facilitating participation for people with CP involves substantial expense. The cost burden of CP highlights the

Methods

Publications on the COI/BoD of CP were identified from Ovid Medline, Embase, CINHAL, PsyInfo, Econlit, Health Economic Evaluation Database (HEED) and NHS Economic Evaluation Database (NHS EED) in the Cochrane Library, using the following search terms: costs, health care cost, cost analysis, cost estimates, economic burden, cost-effectiveness, cost-benefit or economic evaluation and CP. Note that articles associated with cost-effectiveness analysis for CP interventions were also assessed but

Results

The search retrieved 917 publications, from which 101 full text reviews were undertaken of publications reporting health care costs, cost analysis; and economic evaluation. From this, a total of 22 relevant publications (including 5 conference abstracts without full text) on the economic burden of CP were included in this review (Fig. 1).

Costs were estimated by various approaches. Costs are generally reported either a “cost per person with CP” or as an “annual cost” for a target population.

Estimated lifetime costs

The Centres for Disease Control and Prevention (CDC) in the US determined national lifetime costs using a California birth cohort in 1992 (Centers for Disease C & Prevention, 1995). Total lifetime costs for CP were approximately US$4.1 billion (adjusted from the reported US$2.4 billion in 1992), which consisted of US$2.2 billion in medical, developmental and special education services and US$1.9 billion in productivity losses. The lifetime costs estimated were US$862,762 per new CP case (with

Cost of illness at a national level

A population-based analysis using the Taiwanese National Health Insurance database reported that children with CP spent an average of US$773 more on medical expenditure than children having other conditions associated with developmental delay (Chang et al., 2013) before the age of 6 years. This study found that medical expenses were higher if the children were boys, were aged 2–3 years old and were hospitalized.

The estimated annual costs of CP in Australia were US$1.5 billion (0.14% of GDP),

Cost of illness in selected samples

An Australian cohort study involving 155 children with CP aged 30–36 months corrected age, found a positive correlation between average traditional therapy cost per child and the degree of gross motor function (Pareezer et al., 2012). The Gross Motor Function Classification System (GMFCS) was used to classify the severity of gross motor function where children with GMFCS 1 have least mobility impairment through to GMFCS V with the most severe mobility impairment. Average total costs for

Indirect economic impacts on the communities and carers

In addition to the healthcare system, the cost impact of CP on unpaid family carers, communities, and the welfare and education systems is significant. Mothers of children with disability reported poorer health, lower family income and lower workforce participation, even though the participants had higher education (Bourke-Taylor et al., 2011). This Australian study found 82% of mothers wanted and needed to work, but were prevented from work participation due to a wide range of issues related

Discussion

The review has highlighted significant economic impacts associated with CP in many countries and settings. If used carefully, such COI information can assist decision makers in their day-to-day decisions. The lifetime cost, for example, can be useful for providing the potential cost offsets from the prevention of new cases of CP. The annual costs of all existing cases, on the other hand, can be useful for financial planning and management purposes. Specific population costs for target groups,

Acknowledgements

This literature review was funded by the Victoria Managed Insurance Authority (VMIA). Special thanks to chief investigators of the Centre of Research Excellence in Cerebral Palsy for comments and feedbacks on this work. Any opinions, findings, and conclusions or recommendations expressed in this paper are those of the author(s) and do not necessarily reflect the views of the VMIA. The authors have no conflicts of interest to declare.

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