Cost-effectiveness analysis of child development evaluation test (CDE test or Prueba EDI) in children under 5 years old in Mexico: a simulation model study

José R. García-Lira, Developmental-Behavioral Pediatrics Service, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
Rita E. Zapata-Vázquez, Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
Alfonso Reyes-López, Centro de Estudios Económicos y Sociales en Salud. Hospital Infantil de México Federico Gómez, Mexico City, México
Antonio Rizzoli-Córdoba, Servicio de Pediatría del Desarrollo y la Conducta, Hospital Infantil de México Federico Gómez, Mexico City, Mexico

Background: The Health Ministry has incorporated the Child Development Evaluation test (CDE test) as the national screening tool for children < 5 years old. The aim of this study is to analyze the cost-effectiveness of the CDE test compared to standard medical consultation in Mexico. Methods: The study was conducted with information available until 2020. A cost-effectiveness analysis was conducted from perspective of the public/social sectors in Mexico with a decision tree model to evaluate the strategies. The time horizon was set at 1 year, no discounting applied. Costs were calculated in Mexican pesos (MXN) at 2019 prices and included both direct/indirect costs. Direct costs encompassed CDE test administration, specialist consultations, and rehabilitation sessions. Indirect costs considered transportation expenses and lost wages related to caregiving. To account for variability and uncertainty, a Monte Carlo simulation with 10,000 iterations was performed. Probabilistic sensitivity analysis was conducted to test robustness of the results. Results: The results confirm that the CDE test consistently outperforms the standard approach, delivering improved outcomes at reduced costs in the majority of scenarios. The incremental net monetary benefit of implementing CDE screening was $44,608 MXN (2019 value), providing additional evidence of its cost-effectiveness. Conclusion: This study suggests that the CDE test is cost-saving from the public and social sector perspective, generating a net increase in both monetary benefits and health outcomes. Furthermore, its implementation is feasible within the Mexican healthcare system, particularly considering its potential to enhance long-term efficiency.

Keywords: Mass screening. Child development. Cost effectiveness. Economic analysis. Screening.