Presentation (CTI)

OBJECTIVES: Absence from school due to illness can adversely affect academic performance, cognitive development, and future economic opportunities. Despite these consequences, the value of a lost school day has not been comprehensively measured in the context of economic evaluation in the United States (U.S.).
METHODS: This review considers three streams of evidence to provide candidate recommendations for quantifying economic consequences of school absenteeism in the U.S. Theme I reviewed pediatric economic evaluations from the Tufts Cost-Effectiveness Analysis (CEA) Registry and the SickKids Pediatric Economic Database Evaluation (PEDE), assessing inclusion of school absenteeism in economic models. Theme II examined "Value of Vaccination" models, specifically pathways linking vaccination to educational outcomes and long-term productivity in low- and middle-income countries. Theme III reviewed published U.S. estimates of market and non-market productivity losses associated with absenteeism among adolescents and adults.
RESULTS: Theme I identified 14,971 and 833 relevant records in the Tufts CEA Registry and PEDE Database, respectively; only three studies included cost estimates of a lost school day, yet did not report assumptions underlying these estimates. Theme II estimated that completion of primary, secondary, and tertiary (college degree or higher) education in low- and middle-income countries was associated with average returns on lifetime earnings of approximately 19%, 13%, and 11%, respectively, reflecting returns for each level of educational attainment rather than additive gains across levels. Theme III established that existing U.S. productivity estimates include market and non-market productivity only for adolescents aged 15-18.
CONCLUSIONS: Current evidence is limited for monetary values or quality-adjusted life year losses associated with specified durations of lost schooling in the U.S. Drawing on empirical data from Themes I-III and adjusting for the U.S. context, this review developed applied examples comparing cost-effectiveness measures, "Value of Vaccination" approaches, and productivity proxies. Future research is needed to empirically validate these estimates in the U.S. setting.