Public payer resource use, costs and parental well-being in children with emerging developmental disabilities

Pre-school children with or at risk of developmental disabilities (DD) have complex health profiles, leading to high multi-sector service utilization. The impacts of these disabilities extend beyond the child, with significant strains observed in parents and families. BRIGHT Coaching is a parent-coaching intervention that empowers parents to navigate systems and manage their child’s emerging DD. This health economic analysis compared the costs to the publicly funded system for parent and child services, household productivity losses, and parental quality of life between families engaged in BRIGHT Coaching and those who did not. The BRIGHT Coaching randomized controlled trial collected data in Quebec, British Columbia, Nova Scotia, and Manitoba, Canada. Families were randomized to intervention or control groups (1:1 ratio) and clustered by province. The Resource Use Questionnaire captured services and household productivity losses reported by parents at baseline and 8 months (post-intervention). Service costs were analyzed from a public payer perspective and indexed to 2024 Canadian dollars; a two-part regression model was used to estimate per-child costs. The 36-Item Short Form Health Survey assessed parental health-related quality of life. The most frequently accessed publicly funded children’s services included speech-language therapies, occupational/physical therapy, and additional health services. No significant differences were observed between the control and intervention groups in median public payer costs, household productivity losses, or parental quality of life. The two-part model estimated mean public payer cost per child across both groups at CAD $2,571.84 (95% CI: $1,800.07, $3,343.62), with the intervention group incurring CAD $1,097.43 ( p- value > 0.05; 95% CI: -$467.44, $2,662.30) higher costs than the control group. Over half of households reported productivity losses, estimated at CAD $9,830.54 per family (95% CI: $7,624.41, $12,036.66). The intervention group had a higher average mental health component score (+ 2.51, p -value > 0.05; 95% CI: -0.025 to 5.05) than the control group at 8 months, suggesting a trend towards improved mental health. The BRIGHT Coaching program has the potential to support parental mental health and service access in families of children with DD. Families continued to experience substantial caregiving burdens despite coaching, highlighting the complex needs and financial challenges of this population. ClinicalTrial.gov NCT03880383 https//clinicaltrials.gov/study/NCT03880383 Registration Date 2019-03-19.