The little things to reduce the burden of disease

The ‘Infuuts’ © Prinses Máxima Centrum voor Kinderoncologie

Health economists often estimate the costs and outcomes of medical interventions, such as new treatments or vaccines. A key part of such evaluations is quantifiability - costs and outcomes must be measurable to assess their value. Although this may seem simple on paper, the process is quite a challenge in practice. Many medical interventions that reduce morbidity and mortality involve complex mechanisms, long-term effects and indirect impacts that challenge even the most sophisticated economic models.

Meanwhile, some of the most difficult interventions to evaluate are those aimed at enhancing quality of life in the short term - particularly for children undergoing treatment. The benefits of small but meaningful changes, such as improving a child’s hospital experience, are inherently difficult to measure. Parents instinctively recognise their value: a kiss on a scraped knee or a Mickey Mouse band-aid can seemingly eliminate pain in an instant. Healthcare workers, too, understand the power of non-medical interventions. Step inside a children's hospital and you will see it firsthand – a place where paediatric care prioritises emotional well-being in ways that adult care does not. After all, when children are happier, parents are too - some evidence even suggests that parental quality of life is significantly linked to their child’s health status.

Over the years, I have encountered simple yet ingenious innovations that make you thank the people that invented them. One well-known example is medical clowns (or Cliniclowns), inspired by Patch Adams. Research has demonstrated that hospital clowns significantly reduce anxiety and pain perception in paediatric patients. Watching a sick child burst into laughter in the presence of a clown can move even the most composed observer to tears.

Another example is the Infuuts (shown in the photo), an IV stand transformed into a ride-on toy, used at the Prinses Máxima Center for Pediatric Oncology. A simple yet brilliant adaptation: since IV poles already have wheels and tricycles are common in hospitals, why not combine the two? Allowing children on drips to move around freely fosters autonomy and joy, which can counteract the psychological burden of hospitalisation. Finally, lowered reception desks and child-sized chairs in hospitals empower young patients to engage directly in conversations about their care, helping to reduce feelings of fear and helplessness.

As a health economist, I instinctively ask: what are the costs and outcomes of these interventions? Could they be considered cost-effective? Standard health economic tools, such as the EQ-5D-Y or the PedsQL, attempt to measure quality of life in children, but they remain imperfect for capturing momentary joy. Despite my professional inclination to quantify everything, some things defy measurement. The cost of a hospital clown’s visit or an IV tricycle can be estimated. The impact on a child’s laughter, resilience, or a parent's relief? Much more difficult. Should I, as a health economist, care about these enhancements? Probably. But do I care when I see my own child smiling in a hospital setting? Not at all.