The cost trajectory of the diagnostic care pathway for children with suspected genetic disorders.

PURPOSE: This study describes the cost trajectory of the standard diagnostic care pathway for children with suspected genetic disorders in British Columbia, Canada. METHODS: Average annual per-patient costs were estimated using medical records review and a caregiver survey for a cohort of 498 children referred to BC Children's and Women's Hospitals (C&W) with unexplained intellectual disability (the TIDE-BC study) and families enrolled in the CAUSES study, which offered diagnostic genome-wide sequencing (GWS; exome and genome sequencing) to 500 families of children with suspected genetic disorders. RESULTS: Direct costs peaked in the first year of patients' diagnostic odyssey, with an average of C$2257 per patient (95% confidence interval [CI] C$2074, C$2441) for diagnostic testing and C$631 (95% CI C$543, C$727) for specialist consultations at C&W. In subsequent years, direct costs accrued at a constant rate, with an estimated annual per-patient cost of C$511 (95% CI C$473, C$551) for diagnostic testing and C$334 (95% CI C$295, C$369) for consultations at C&W. Travel costs and caregiver productivity loss associated with attending diagnosis-related physician appointments averaged C$1907/family/year. CONCLUSIONS: The continuing long-term accrual of costs by undiagnosed patients suggests that economic evaluations of diagnostic GWS services should use longer time horizons than have typically been used.

Costs of caring for children with an intellectual developmental disorder.

BACKGROUND: Caring for a child with intellectual developmental disorder (IDD) is expensive for the medical system, for the family, and for society in general. Whereas the health care costs of IDD have been described, the societal and parental costs of IDD have been less well documented. OBJECTIVE: Our goal was to estimate the out-of-pocket costs to parents, and the non-health system costs to society, of raising a child with IDD. METHODS: We used an online retrospective survey, previously developed by our group, to collect parental and societal costs to families of 80 children who presented with IDD of unknown etiology in British Columbia, Canada. RESULTS: Median annual parental costs of caring for 80 children with IDD was CAD$44,570 (range CAD$2245-$225,777). The largest contributors to parental costs were income loss and caregiving time costs. Median annual societal costs (excluding health system costs) were CAD$27,428 (range CAD$0-$119,188). In school age children, the largest contributor to societal costs was a per child school subsidy. Both parental and societal costs increased with increasing IDD severity. Parental costs were not adequately compensated by government benefits received. CONCLUSIONS: Although medical care is universally available through Canadian provincial health systems and social assistance is provided to the families of children with IDD, parents continue to bear a substantial financial burden beyond that associated with raising an unaffected child.