title: The association between neurodevelopmental disability and economic outcomes during mid-childhood.
abstract: 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 [standard error (SE): £141] among children without neurodevelopmental impairment, £831 (£112) among children with a mild neurodevelopmental impairment, £1053 (£176) among children with a moderate neurodevelopmental impairment and £1662 (£316) among children with a severe neurodevelopmental impairment. Mean health and social service costs were estimated at £1223 (£157) and £695 (£92) 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 (95% CI: £86, £707; P= 0.012), £655 (95% CI: £167, £1144; P= 0.009) and £1065 (95% CI: -£113, £2243; 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.
authors.affiliation: Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, London, UK. s.petrou@warwick.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Petrou
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: D
authors.initials: D
authors.lastname: Wolke
authors.forename: N
authors.initials: N
authors.lastname: Marlow
mesh_terms: D000328:Adult; D002648:Child; D002658:Developmental Disabilities / Q000191:economics* / Q000453:epidemiology; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007494:Ireland / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D012720:Severity of Illness Index; D012947:Social Work / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology