title: The generation gap: differences between children and adults pertinent to economic evaluations of health interventions.
abstract: Differences between children and adults have both technical and ethical implications for the design, interpretation and employment of economic analyses of health-related programmes. Even though policy makers increasingly turn to economic analyses to inform decisions about resource allocation, pertinent child-adult differences have received fragmented discussion in leading methodological references. Key areas warranting attention include: the ways in which a child's distinctive biology modifies the cost and effectiveness of healthcare interventions; challenges in assessing utilities for infants and young children given their limited but developing cognitive capacity; how a child's age, dependency and disability affect the selection of the appropriate time horizon and scope of the analysis; whether a child's non-wage earning productivity should be incorporated into analyses, and if so, what metric to use; what principles of equity policy makers should employ in using economic evaluations to choose between child- and adult-focused interventions; and whether special protective measures should be introduced to secure the rights and interests of children who cannot advocate for themselves.
authors.affiliation: General Pediatrics, Pediatric Generalist Research Group, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pennsylvania, USA. keren@email.chop.edu
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D000328:Adult; D002648:Child; D002651:Child Advocacy; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000941:ethics; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics; D006291:Health Policy; D006295:Health Resources / Q000191:economics* / Q000941:ethics*; D006801:Humans; D016901:Intergenerational Relations; D011050:Policy Making; D011057:Politics; D012959:Socioeconomic Factors; D014481:United States