Impacts beyond the child: A theoretical framework of pediatric economic evaluation from a family perspective

A child's health significantly affects the health, well-being, and economic welfare of family members. However, family spillovers are often excluded from pediatric economic evaluations due to the absence of established theoretical frameworks to guide their incorporation and practical challenges in measuring, valuing and incorporating these effects. This study develops a theoretical framework and proposes a framework to incorporate family spillovers into pediatric economic evaluation. A scoping review identified sixteen interdisciplinary theories and frameworks from psychology, economics, health services research, and related fields that support pediatric family spillovers considerations and a family-level approach to child health, development, and care. Using critical interpretative synthesis, findings were synthesized into a theoretical framework, which informed a framework for incorporating family spillovers into pediatric cost-utility analysis. Synthesis led to five key concepts underpinning a family perspective in pediatric economic evaluation: (1) interdependency in family members' health and well-being, (2) maximizing family members' health and well-being, (3) collating the collective family costs, (4) specifying the family as the unit, and (5) considering factors influencing child health and development. Conducting pediatric economic evaluations from a family perspective requires treating family as the unit of analysis and incorporating costs and consequences of a child's illness or disability across all family members. We propose a framework to estimate total family costs and quality-adjusted life years (QALYs) by aggregating family members' costs and QALYs. This theoretical framework affirms the inclusion of family spillovers in pediatric economic evaluations, enabling comprehensive assessments and informing policies to improve the health and wellbeing of not only children but families.