Title: Cost-effectiveness of earlier provision of powered mobility interventions for children with mobility limitations: evidence synthesis and economic model
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Design: We will undertake a mixed-method evidence synthesis followed by economic modelling to determine the relative costs and effects of early powered mobility. We will utilise published evidence, grey literature and other existing economic data from NHS and third sector organisations. An upfront logic model will be used as a conceptual starting point and cumulatively developed throughout the review. Setting/context: The provider setting is predominantly, but not exclusively, allied health and wheelchair services which provide mobility interventions for children, and any third sector providers that these services work with for powered mobility provision. The wider context includes family, education, communities, and social care. Target population: The target population is children with mobility limitations, described in terms of the child’s ability to move around. We anticipate that studies will use standardised classification systems (e.g. the Gross Motor Function Classification System); codes from the WHO International Classification of Health, Functioning, and Disability; or clinical observations. Health technologies being assessed: The health technology of interest is powered mobility equipment for children under 5 years, and the comparator is equivalent equipment for children aged 5 years and over. The exact features of these interventions vary depending on the child’s age and/or developmental stage and impairments. Generally, these interventions consist of five elements: 1) The powered mobility equipment; 2) Adaptations to physical environment; 3) Adaptations to policies and practices; 4) Training and other behaviour change techniques; 5) Maintenance. Costs and outcomes: We will consider all relevant outcomes, including (but not restricted to): the child’s abilities in everyday tasks (‘life skills’), independence, autonomy and participation; parental physical and mental health; and health, social care and education costs. To estimate cost-effectiveness, we will include a range of costs: mobility equipment, customisation/adaptation, staff time, training, maintenance and environmental adaptations. We will also consider wider economics impacts to the family and society. Evidence synthesis strategy: The evidence synthesis will follow established principles for conducting effectiveness and cost-effectiveness systematic reviews (e.g. CRD, 2009). Papers will be screened and data extracted by two reviewers. Evidence will be streamed and synthesised by type of data (i.e. quantitative, qualitative), followed by an overarching synthesis. Narrative summary and framework synthesis will be used to synthesise evidence within/between streams. Method-specific tools will be used to assess methodological limitations of included studies (Cochrane risk of bias tool; CASP qualitative checklist; Mixed Method Appraisal tool). GRADE and GRADE CERQual will be applied to synthesised findings. Economic model: We will develop a Markov model to estimate the cost-effectiveness of early powered mobility, using evidence from the review, cost data and child development literature to estimate the impact of independent mobility (initiated before/after the age of 5) on the attainment of development milestones and other outcomes in the short- and long-term Expertise: The research team has a wide range of expertise in systematic reviewing, economic modelling and evidence synthesis. The team also has clinical expertise, and direct service user experience.

Lay abstract: Aim: We want to estimate the costs and benefits of providing very young disabled children (under 5 years) with powered mobility aids (e.g. mini wheelchairs, ride-on-cars). We will: (1) combine the results of existing research; and (2) use a technique called economic modelling to predict how cost-effective it is to provide powered mobility aids from a very early age. Background: More than 70,000 children in the UK use special equipment, such as wheelchairs, to help them move around. There are lots of different reasons why children may have issues with their mobility, and for some children powered or electric mobility aids (such as powered wheelchairs) may be the only way to move around on their own. Helping children under the age of 5 to move around on their own can have long-lasting benefits, including physical and mental development, increased independence and more participation in everyday life. These benefits can also have positive impacts on the physical and mental health of children’s parents, and may reduce later health, social care and education costs. What is currently unknown is whether providing powered mobility aids for very young children provides more benefits than waiting until after the child is aged 5. The NHS is the largest UK provider of powered mobility aids for children, but there is often variation in what different NHS services provide, particularly for children under the age of 5. At the moment there is no national guidance to help NHS services decide the best age to start providing powered mobility aids for children, or what costs and the benefits to consider. Design and methods: We will gather all existing research and evidence about the costs and benefits of powered mobility aids for children. We will look at the quality of the evidence and combine all relevant information to get a better understanding of the extra costs and benefits of providing powered mobility aids (and related training and support) at a very early age, rather than waiting until after a child turns 5. Using this information we will develop an economic model, which will allow us to estimate whether the extra benefits of early powered mobility outweigh the additional costs. Patient and public involvement (PPI): It is important that this research includes the views and experiences of children who use powered mobility aids, and the views of their parents. We plan to include up to three parents of children who use powered mobility aids in the Project Advisory Group. Their role will be to advise on the lived experience of very young children who use powered mobility aids. We will also work with four young people (aged under 18 years) who use powered mobility aids to produce an engaging animation and booklet to summarise the results. We will engage with very young children and invite them to provide visual materials, such as pictures and videos, about their powered mobility aids to include in the animation. One of the co-applicants for this project is a powered mobility aid user. Dissemination: We will share our findings by publishing articles in scientific journals, presenting at conferences and writing a report. We will also hold a launch event for the animation and booklet.

Research activity codes: 6.3 MEDICAL DEVICES
Health categories: GENERIC HEALTH RELEVANCE