ECONOMIC MODELLING OF POLICY SCENARIOS FOR REDUCING GEOGRAPHIC INEQUITY IN FAMILY OUT-OF-POCKET COSTS FOR NEURODEVELOPMENTAL SUPPORT IN CHILDREN WITH CONGENITAL HEART DISEASE
Author(s)
Steven M. McPhail, PhD1, Benjamin C. Auld, MBBS2, Karen J. Eagleson, PhD2, Robert Justo, MBBS2, Susan Pagel, BSpPath2, Thomasina Donovan, PhD3, Pakhi Sharma, PhD3, Sameera Senanayake, PhD4, Sanjeewa Kularatna, PhD4, Bridget Abell, PhD3.
1Centre Director and Professor of Health Services Research, Queensland University of Technology, Brisbane, Australia, 2Children's Health Queensland, Brisbane, Australia, 3Queensland University of Technology, Brisbane, Australia, 4Duke-NUS Medical School, Singapore, Singapore.
1Centre Director and Professor of Health Services Research, Queensland University of Technology, Brisbane, Australia, 2Children's Health Queensland, Brisbane, Australia, 3Queensland University of Technology, Brisbane, Australia, 4Duke-NUS Medical School, Singapore, Singapore.
OBJECTIVES: To estimate out-of-pocket costs incurred by families of children with congenital heart disease requiring neurodevelopmental support, and to evaluate the impact of alternative service delivery model policies on financial burden and geographic inequity in a large Australian state.
METHODS: An analysis of out-of-pocket costs was undertaken using person-level stochastic microsimulation informed by a representative paediatric cardiac cohort in Queensland, Australia (n=957), with geographically dispersed residential locations that included 289 (30%) families residing outside the urbanised South East Queensland region. Geographic information systems were used to map residential locations and healthcare providers and to derive travel time and distance. Out-of-pocket costs, including direct healthcare, direct non-healthcare (travel), and indirect productivity losses for families, were estimated over the first five years of life across four illustrative levels of neurodevelopmental support requirements: surveillance only, mild, moderate or severe delays. Three policy scenarios were compared in the context of existing health system structures, funding arrangements and subsidies: tertiary centre-based care, nearest secondary paediatric centre, and community-based care. Estimates were generated from 10,000 simulations of 1000 families per scenario, with probabilistic sensitivity analyses.
RESULTS: Out-of-pocket costs were high across all scenarios and increased sharply with support need levels. Family productivity losses were the dominant cost driver. Under a tertiary model, costs rose from AU$3,154 (surveillance) to AU$36,066 (severe delays). The secondary-centre model consistently minimised costs (AU$3,089 to AU$26,999). Community-based care was the highest-cost option, reaching AU$48,860 for severe delays with families accessing multiple private community-based providers. Geographic inequity was substantial: for severe delays, tertiary-centre scenario costs were approximately AU$28,497 in urbanised South East Queensland compared with AU$54,370 outside the region.
CONCLUSIONS: Out-of-pocket costs for neurodevelopmental care are substantial and strongly impacted by geography and clinical need. Decentralisation to secondary paediatric centres represents a cost-minimising strategy for families and potentially represents a practical policy lever to reduce geographic inequity.
METHODS: An analysis of out-of-pocket costs was undertaken using person-level stochastic microsimulation informed by a representative paediatric cardiac cohort in Queensland, Australia (n=957), with geographically dispersed residential locations that included 289 (30%) families residing outside the urbanised South East Queensland region. Geographic information systems were used to map residential locations and healthcare providers and to derive travel time and distance. Out-of-pocket costs, including direct healthcare, direct non-healthcare (travel), and indirect productivity losses for families, were estimated over the first five years of life across four illustrative levels of neurodevelopmental support requirements: surveillance only, mild, moderate or severe delays. Three policy scenarios were compared in the context of existing health system structures, funding arrangements and subsidies: tertiary centre-based care, nearest secondary paediatric centre, and community-based care. Estimates were generated from 10,000 simulations of 1000 families per scenario, with probabilistic sensitivity analyses.
RESULTS: Out-of-pocket costs were high across all scenarios and increased sharply with support need levels. Family productivity losses were the dominant cost driver. Under a tertiary model, costs rose from AU$3,154 (surveillance) to AU$36,066 (severe delays). The secondary-centre model consistently minimised costs (AU$3,089 to AU$26,999). Community-based care was the highest-cost option, reaching AU$48,860 for severe delays with families accessing multiple private community-based providers. Geographic inequity was substantial: for severe delays, tertiary-centre scenario costs were approximately AU$28,497 in urbanised South East Queensland compared with AU$54,370 outside the region.
CONCLUSIONS: Out-of-pocket costs for neurodevelopmental care are substantial and strongly impacted by geography and clinical need. Decentralisation to secondary paediatric centres represents a cost-minimising strategy for families and potentially represents a practical policy lever to reduce geographic inequity.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HSD12
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Neurological Disorders, SDC: Pediatrics