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The Generation Gap

Differences Between Children and Adults Pertinent to Economic Evaluations of Health Interventions

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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.

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Acknowledgements

We thank David Asch, Tracy Lieu, David Mandell, and Louise Warren for their help and thoughtful comments.

Dr Feudtner was supported by grant number K08 HS00002 from the Agency for Healthcare Research and Quality.

Dr. Keren was supported by grant number K23 HD043179 from the National Institute of Child Health and Human Development, Bethesda, MD.

The authors have no conflicts of interest that are directly relevant to the contents of this manuscript.

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Correspondence to Ron Keren.

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Keren, R., Pati, S. & Feudtner, C. The Generation Gap. PharmacoEconomics 22, 71–81 (2004). https://doi.org/10.2165/00019053-200422020-00001

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