Methodological challenges posed by economic evaluations of early childhood intervention programmes.

Early childhood intervention programmes have emerged in recent years with the aim of fostering the cognitive and social-emotional functioning and physical health of preschool children and enhancing their emerging competencies. This article presents a structured critical appraisal of economic evaluations of early childhood intervention programmes. It highlights a range of methodological issues in the field. These include: the fidelity of the evaluation process; the selection of the appropriate comparison group given the complexity of care routinely provided; the appropriate perspective and coverage of the study; methodological concerns relating to cost and benefit measurement and valuation; analytical requirements relating to the form of sensitivity analysis and the decision rules adopted by decision makers; and the interpretation of the results in the light of contextual factors. It is concluded that more transparent methodological guidance is required for analysts conducting economic evaluations of early childhood intervention programmes in particular and of public health interventions in general. Greater multidisciplinary collaboration between social scientists should also enhance the development of ground-breaking methods in this field.