AN ECONOMIC-ANALYSIS OF DEVELOPMENTAL DETECTION METHODS

Objective. To assess the costs and benefits of various approaches to e arly detection of developmental disabilities. Design. Cost-benefit ana lyses based on data from previously published studies of developmental screening tests. Setting. General pediatric practices and day care ce nters. Patients and Other Participants. A total of 247 parents and the ir 0- to 6-year-old children-103 from day care centers and 144 from pe diatric practices. Main Outcome Measures. Licensed psychological exami ners administered a screening test of parents' concerns about children 's development and one or two direct screening tests: the Denver-II an d/or the Battelle Developmental Inventory Screening Test. For the day care sample, examiners also administered to each child measures of int elligence, adaptive behavior, and language. In the pediatric sample, c hildren were administered additional assessments. At the same time, di agnostic measures were administered to a randomly selected subsample t o make determinations about developmental status. Each screening metho d was evaluated for its short-term costs (administration, interpretati on, diagnosis, and treatment) and long-term benefits (impact of early intervention on adult functioning as inferred from longitudinal studie s by other researchers). Results. When the long-term costs and benefit s were considered, none of the approaches emerged as markedly superior to another. When viewing the short-term costs, the various screening approaches differed markedly. The use of parents' concerns was by far the least costly for physicians to administer and interpret, Conclusio n. Physicians tan incur tremendous expenses when attempting to detect children with developmental problems. Although the benefits of early d efection and intervention are substantial, physicians are not well-com pensated for providing a critical service to society. Health policymak ers and third-party payers must reconsider their minimal investment in early detection by health care providers. Nevertheless, our findings have encouraging implications for practice, because the use of parents ' concerns as a screening technique offers substantial savings over an d above other methods.