Wheelchairs provide a wide range of benefits to disabled children, including positive health, developmental and social outcomes. National and international reports have highlighted the need for improved access to wheelchairs for disabled children. Health economics could have an important role in ensuring that the most cost-effective equipment is provided to children. Due to a lack of
economic evidence this is not currently possible. NICE cannot provide clear and reliable guidance to the NHS without appropriate evidence of effectiveness and cost-effectiveness. NICE recommend the QALY as their primary measure of choice. It is therefore paramount to understand how to apply health economics methods of evaluation to wheelchair interventions.
The overall aim of this thesis was to explore the application of health economics to wheelchair interventions for disabled children, and to understand how best to evaluate the cost-effectiveness of wheelchair interventions for children. A number of techniques were used, including: a mixed-method systematic review (chapter three); a wheelchair costing case study (chapter four); a pilot discrete choice experiment to understand wheelchair service user priorities (chapter five); a quantitative statistical analysis of health-related quality of life outcome measures (chapter six); and a qualitative explorative study of how disabled children define quality of life (chapter seven).
This thesis represents the first academic application of health economics to wheelchair interventions for disabled children. The use of generic preference-based HRQoL outcome measures may not be suitable in disabled children, particularly younger children. Future research should ensure use of mixed methods, including qualitative methods. If the use of QALYs is continued in this setting, more robust and sensitive methods of utility data collection are needed. Alternatively the capability approach could be used in place of QALYs. Evidence of cost-effectiveness has the potential to promote reform of NHS wheelchair services and subsequently improve outcomes for disabled children.