Burden Tree – a conceptual framework for the burden associated with pediatric infectious diseases: a Delphi approach

BACKGROUND: Accurate economic evaluations require capturing the full value of health interventions, yet broader impacts are often inconsistently represented. This study developed and validated the 'Burden Tree'- a conceptual framework to comprehensively capture the burden of pediatric infectious diseases on patients and families. METHODS: A double-blind modified-Delphi panel was conducted with 21 experts from the US and Europe in pediatric infectious diseases. The process, informed by targeted literature review and expert input, involved two rounds of online surveys and a virtual consensus meeting to elicit and validate categories, elements, and sub-elements of the Burden Tree. RESULTS: Burden Tree categories included direct medical and non-medical costs, productivity losses, and impact on quality of life, each differentiating elements before, during, and after the episode. Validated sub-elements covered costs related to hospitalizations, drugs, visits, tests, healthcare transport, caregiver bereavement or exhaustion; housing modifications, special accommodations and resources for sequelae; caregiver and patient absenteeism and presenteeism, caregiver employment termination; caregiver and patient changes in health-related quality of life, and discrimination following the episode. The panel agreed the Burden Tree categories were comprehensive, mutually exclusive, and customizable. CONCLUSION: This modified-Delphi panel validated a comprehensive and mutually exclusive framework for economic evaluation inclusion.