Children and Young People's Health Partnership Evelina London Model of Care: economic evaluation protocol of a complex system change

Marina Soley-Bori, Raghu Lingam, Rose-Marie Satherley, Julia Forman, Lizzie Cecil, Julia Fox-Rushby, Ingrid Wolfe, Marina Soley-Bori, Raghu Lingam, Rose-Marie Satherley, Julia Forman, Lizzie Cecil, Julia Fox-Rushby, Ingrid Wolfe

Abstract

Introduction: The Children and Young People's Health Partnership (CYPHP) Evelina London Model of Care is a new approach to integrated care delivery for children and young people (CYP) with common health complaints and chronic conditions. CYPHP includes population health management (services shaped by data-driven understanding of population and individual needs, applied in this case to enable proactive case finding and tailored biopsychosocial care), specialist clinics with multidisciplinary health teams and training resources for professionals working with CYP. This complex health system strengthening programme has been implemented in South London since April 2018 and will be evaluated using a cluster randomised controlled trial with an embedded process evaluation. This protocol describes the within-trial and beyond-trial economic evaluation of CYPHP.

Methods and analysis: The economic evaluation will identify, measure and value resources and health outcome impacts of CYPHP compared with enhanced usual care from a National Health Service/Personal Social Service and a broader societal perspective. The study population includes 90 000 CYP under 16 years of age in 23 clusters (groups of general practitioner (GP) practices) to assess health service use and costs, with more detailed cost-effectiveness analysis of a targeted sample of 2138 CYP with asthma, eczema or constipation (tracer conditions). For the cost-effectiveness analysis, health outcomes will be measured using the Paediatric Quality of Life Inventory and quality-adjusted life years (QALYs) using the Child Health Utility 9 Dimensions (CHU-9D) measure. To account for changes in parental well-being, the Warwick-Edinburg Mental Well-being Scale will be integrated with QALYs in a cost-benefit analysis. The within-trial economic evaluation will be complemented by a novel long-term model that expands the analytical horizon to 10 years. Analyses will adhere to good practice guidelines and National Institute for Health and Care Excellence public health reference case.

Ethics and dissemination: The study has received ethical approval from South West-Cornwall and Plymouth Research Ethics Committee (REC Reference: 17/SW/0275). Results will be submitted for publication in peer-reviewed journals, made available in briefing papers for local decision-makers, and provided to the local community through website and public events. Findings will be generalisable to community-based models of care, especially in urban settings.

Trial registration number: NCT03461848.

Keywords: health economics; health policy; paediatrics.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study population and intervention flow. CYP, children and young people; CYPHP, Children and Young People’s Health Partnership; GP, general practitioner.

References

    1. Cheung R. International comparisons of health and wellbeing in early childhood. London Nuffield Trust, 2018.
    1. OECD . Health Status : Maternal and infant mortality [Internet]. Available: [Accessed 17 Sep 2020].
    1. Wolfe I, Thompson M, Gill P, et al. . Health services for children in Western Europe. Lancet 2013;381:1224–34. 10.1016/S0140-6736(12)62085-6
    1. Wolfe I, Macfarlane A, Donkin A. Why children die: death in infants, children, and young people in the UK—Part a. Lond R Coll Paediatr Child Health, 2014.
    1. Davies SC, Lemer C, Strelitz J, et al. . Our children deserve better: prevention pays. Lancet 2013;382:1383–4. 10.1016/S0140-6736(13)62004-8
    1. Hoey H, Aanstoot HJ, Chiarelli F, et al. . Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes. Diabetes Care 2001;24:1923–8. 10.2337/diacare.24.11.1923
    1. Sundbom F, Malinovschi A, Lindberg E, et al. . Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics. J Asthma 2016;53:398–403. 10.3109/02770903.2015.1126846
    1. Boyd M, Lasserson TJ, McKean MC, et al. . Interventions for educating children who are at risk of asthma-related emergency department attendance. Cochrane Database Syst Rev 2009;2:CD001290. 10.1002/14651858.CD001290.pub2
    1. Ordoñez GA, Phelan PD, Olinsky A, et al. . Preventable factors in hospital admissions for asthma. Arch Dis Child 1998;78:143–7. 10.1136/adc.78.2.143
    1. Castro M, Zimmermann NA, Crocker S, et al. . Asthma intervention program prevents readmissions in high healthcare users. Am J Respir Crit Care Med 2003;168:1095–9. 10.1164/rccm.200208-877OC
    1. Nunes C, Ladeira S, Asthma LS. Asthma, from childhood to adulthood: a prospective 20-year longitudinal study of a cohort of asthmatics. J Investig Allergol Clin Immunol 2002;12:242–9.
    1. Stevens CA, Turner D, Kuehni CE, et al. . The economic impact of preschool asthma and wheeze. Eur Respir J 2003;21:1000–6. 10.1183/09031936.03.00057002
    1. UNICEF . Convention on the Rights of the Child [Internet]. Available: [Accessed 03 Oct 2020].
    1. Belli PC, Bustreo F, Preker A. Investing in children's health: what are the economic benefits? Bull World Health Organ 2005;83:777–84.
    1. Guyer B, Ma S, Grason H. INVESTMENTS TO PROMOTE CHILDREN ‘S HEALTH: A systematic literature review and economic analysis of interventions in the preschool period. Baltim MD Johns Hopkins Bloom Sch Public Health, 2008.
    1. Wolfe I, Satherley R-M, Scotney E, et al. . Integrated care models and child health: a meta-analysis. Pediatrics 2020;145:e20183747. 10.1542/peds.2018-3747
    1. . 2019 child health profiles [Internet]. Available: [Accessed 13 Feb 2020].
    1. Newham JJ, Forman J, Heys M, et al. . Children and young people's health partnership (CYPHP) Evelina London model of care: protocol for an opportunistic cluster randomised controlled trial (cRCT) to assess child health outcomes, healthcare quality and health service use. BMJ Open 2019;9:e027301. 10.1136/bmjopen-2018-027301
    1. Satherley R-M, Green J, Sevdalis N, et al. . The Children and Young People’s Health Partnership Evelina London Model of Care: process evaluation protocol. BMJ Open 2019;9:e027302. 10.1136/bmjopen-2018-027302
    1. Tramonti F, Giorgi F, Fanali A. Systems thinking and the biopsychosocial approach: a multilevel framework for patient‐centred care. Syst Res Behav Sci 2021;38:215–30. 10.1002/sres.2725
    1. NICE . Guide to the methods of technology appraisal 2013 [Internet], 2013. Available:
    1. Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients' perspective. Arch Dermatol 2004;140:1513–9. 10.1001/archderm.140.12.1513
    1. Nathan RA, Sorkness CA, Kosinski M, et al. . Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004;113:59–65. 10.1016/j.jaci.2003.09.008
    1. Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 2001;40:1337–45. 10.1097/00004583-200111000-00015
    1. Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care 1999;37:126–39. 10.1097/00005650-199902000-00003
    1. Furber G, Segal L. The validity of the child health utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services. Health Qual Life Outcomes 2015;13:22. 10.1186/s12955-015-0218-4
    1. Institute for Women and Children’s Health, King’s Health Partners, London, UK . Children and Young People’s CHILDS (Children’s Health Integrated Care and Learning Delivery System) framework. [Internet]. Available:
    1. PSSRU . Unit Costs of Health and Social Care 2020 [Internet], 2020. Available:
    1. . NHS reference costs 2015 to 2016 [Internet]. Available: [Accessed 21 May 2020].
    1. Franklin M, Lomas J, Walker S, et al. . An educational review about using cost data for the purpose of cost-effectiveness analysis. Pharmacoeconomics 2019;37:631–43. 10.1007/s40273-019-00771-y
    1. Mantopoulos T, Mitchell PM, Welton NJ, et al. . Choice of statistical model for cost-effectiveness analysis and covariate adjustment: empirical application of prominent models and assessment of their results. Eur J Health Econ 2016;17:927–38. 10.1007/s10198-015-0731-8
    1. NICE . Methods for the development of NICE public health guidance (third edition, 2013.
    1. Glick HA, Doshi JA, Sonnad SS. Economic evaluation in clinical trials. OUP Oxford, 2014.
    1. Fox-Rushby J, Cairns J. Economic evaluation. McGraw-Hill Education (UK), 2005.
    1. Ramsey SD, Willke RJ, Glick H, et al. . Cost-Effectiveness analysis alongside clinical trials II-An ISPOR good research practices Task force report. Value Health 2015;18:161–72. 10.1016/j.jval.2015.02.001
    1. Curtis L. Unit costs of health and social care. Personal Social Services Research Unit: University of Kent, 2014.
    1. Chan KS, Mangione-Smith R, Burwinkle TM, et al. . The PedsQL: reliability and validity of the short-form generic core scales and asthma module. Med Care 2005;43:256–65. 10.1097/00005650-200503000-00008
    1. Seid M, Limbers CA, Driscoll KA, et al. . Reliability, validity, and responsiveness of the pediatric quality of life inventory (PedsQL) generic core scales and asthma symptoms scale in vulnerable children with asthma. J Asthma 2010;47:170–7. 10.3109/02770900903533966
    1. Stevens K. Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Qual Life Res 2009;18:1105–13. 10.1007/s11136-009-9524-9
    1. Stevens K. Assessing the performance of a new generic measure of health-related quality of life for children and refining it for use in health state valuation. Appl Health Econ Health Policy 2011;9:157–69. 10.2165/11587350-000000000-00000
    1. Tennant R, Hiller L, Fishwick R, et al. . The Warwick-Edinburgh mental well-being scale (WEMWBS): development and UK validation. Health Qual Life Outcomes 2007;5:63. 10.1186/1477-7525-5-63
    1. NICE . 6 Incorporating health economics | Methods for the development of NICE public health guidance (third edition) | Guidance | NICE [Internet]. NICE. Available: [Accessed 02 Mar 2020].
    1. Trotter L, Rallings Adams M-K. Valuing improvements in mental health: applying the wellbeing valuation method to WEMWBS. HACT, 2017.
    1. Gomes M, Grieve R, Nixon R, et al. . Methods for covariate adjustment in cost-effectiveness analysis that use cluster randomised trials. Health Econ 2012;21:1101–18. 10.1002/hec.2812
    1. Manca A, Hawkins N, Sculpher MJ. Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ 2005;14:487–96. 10.1002/hec.944
    1. Hernández Alava M, Wailoo AJ, Ara R. Tails from the peak district: adjusted limited dependent variable mixture models of EQ-5D questionnaire health state utility values. Value Health 2012;15:550–61. 10.1016/j.jval.2011.12.014
    1. DiazOrdaz K, Kenward MG, Gomes M, et al. . Multiple imputation methods for bivariate outcomes in cluster randomised trials. Stat Med 2016;35:3482–96. 10. 10.1002/sim.6935
    1. Allison PD. Missing Data [Internet. SAGE Publications Inc, 2020.
    1. Chaudhary MA, Stearns SC. Estimating confidence intervals for cost-effectiveness ratios: an example from a randomized trial. Stat Med 1996;15:1447–58. 10.1002/(SICI)1097-0258(19960715)15:13<1447::AID-SIM267>;2-V
    1. Frew EJ, Pallan M, Lancashire E, et al. . Is utility-based quality of life associated with overweight in children? Evidence from the UK waves randomised controlled study. BMC Pediatr 2015;15:10.1186/s12887-015-0526-1. 10.1186/s12887-015-0526-1
    1. Sullivan SD, Weiss KB, Lynn H, et al. . The cost-effectiveness of an inner-city asthma intervention for children. J Allergy Clin Immunol 2002;110:576–81. 10.1067/mai.2002.128009
    1. Madge P, McColl J, Paton J. Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study. Thorax 1997;52:223–8. 10.1136/thx.52.3.223
    1. Noyes K, Bajorska A, Fisher S, et al. . Cost-Effectiveness of the school-based asthma therapy (SBAT) program. Pediatrics 2013;131:e709–17. 10.1542/peds.2012-1883
    1. Franco R, Santos AC, do Nascimento HF, et al. . Cost-effectiveness analysis of a state funded programme for control of severe asthma. BMC Public Health 2007;7:82. 10.1186/1471-2458-7-82
    1. Schuttelaar MLA, Vermeulen KM, Coenraads PJ. Costs and cost-effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs. Br J Dermatol 2011;165:10.1111/j.1365-2133.2011.10470.x:600–11. 10.1111/j.1365-2133.2011.10470.x
    1. Ismail N, Ratchford I, Proudfoot C, et al. . Impact of a nurse-led clinic for chronic constipation in children. J Child Health Care 2011;15:10.1177/1367493511406568:221–9. 10.1177/1367493511406568
    1. Andersson M, Hedman L, Bjerg A, et al. . Remission and persistence of asthma followed from 7 to 19 years of age. Pediatrics 2013;132:e435–42. 10.1542/peds.2013-0741
    1. Abuabara K, Hoffstad O, Troxel A, et al. . Atopic dermatitis disease control and age: a cohort study. J Allergy Clin Immunol 2015;136:190–2. 10.1016/j.jaci.2015.03.028
    1. Ridd MJ, King AJL, Le Roux E, et al. . Systematic review of self-management interventions for people with eczema. Br J Dermatol 2017;177:719–34. 10.1111/bjd.15601
    1. Auth MKH, Vora R, Farrelly P, et al. . Childhood constipation. BMJ 2012;345:e7309. 10.1136/bmj.e7309
    1. Bongers MEJ, van Wijk MP, Reitsma JB, et al. . Long-term prognosis for childhood constipation: clinical outcomes in adulthood. Pediatrics 2010;126:e156–62. 10.1542/peds.2009-1009

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