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Application of Classic Utilities to Published Pediatric Cost-Utility Studies

  • S. Maria E. Finnell
    Correspondence
    Address correspondence to S. Maria E. Finnell, MD, MS, Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, HITS Building, Rm 1020N, 410 West 10th St., Indianapolis, IN 46202.
    Affiliations
    Department of Pediatrics, Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Ind

    Regenstrief Institute for Healthcare, Indianapolis, Ind
    Search for articles by this author
  • Aaron E. Carroll
    Affiliations
    Department of Pediatrics, Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Ind

    Center for Health Policy and Professionalism Research, Indianapolis, Ind

    Regenstrief Institute for Healthcare, Indianapolis, Ind
    Search for articles by this author
  • Stephen M. Downs
    Affiliations
    Department of Pediatrics, Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Ind

    Center for Health Policy and Professionalism Research, Indianapolis, Ind

    Regenstrief Institute for Healthcare, Indianapolis, Ind
    Search for articles by this author
Published:November 11, 2011DOI:https://doi.org/10.1016/j.acap.2011.09.003

      Abstract

      Objective

      Economic analyses, such as cost-utility analyses (CUAs), are dependent on the quality of the data used. Our objective was to test how health utility values (measurements of patient preference) assessed by recommended methods (classic utilities) would impact the conclusions in published pediatric CUAs.

      Methods

      Classic utilities for pediatric health states were obtained by recommended utility assessment methods, time trade-off, and standard gamble in 4016 parent interviews. To test the impact of these utilities on published studies, we obtained a sample of published pediatric CUAs by searching Medline, EMBASE, EconLit, Health Technology Assessment Database, Cochrane Database on Systematic Reviews, Database of Abstracts of Reviews of Effects, and the Cost Effective Analysis (CEA) Registry at Tufts Medical Center, using search terms for cost-utility analysis. Articles were included when results were presented as cost per quality adjusted life-years (QALYs), the interventions were for children <18 years of age and included at least one of the following health states: attention deficit hyperactivity disorder, asthma, gastroenteritis, hearing loss, mental retardation, otitis media, seizure disorder, or vision loss. Studies that did not include these or equivalent health states were excluded. For each CUA, we determined utilities (values for patient preference), the utility assessment method used, and presence of one-way sensitivity analyses (SAs) on utilities. When one-way SAs were conducted, we determined if using our classic utilities would change the result of the CUA. When an SA was not presented, we determined if using our classic utilities would tend to support or not support the published conclusions.

      Results

      We evaluated 39 articles. Eighteen articles presented results of one-way SAs on utilities. Seven articles presented SAs over a range that included our classic utilities. In 4 of the 7, using classic utilities would change the conclusion of the study. For the 32 articles where no one-way SA were presented (n = 21), or where the classic utilities fell outside the range tested (n =11), a change to classic utility would tend against the study conclusion in 12 articles (31%).

      Conclusions

      More than a third of published CUA studies could change if pediatric utilities obtained by recommended, classic methods were used. One-way SAs on utilities are often not presented, making comparison between studies challenging.

      Keywords

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      References

        • Ungar W.J.
        • Santos M.T.
        Trends in paediatric health economic evaluation: 1980 to 1999.
        Arch Dis Child. 2004; 89: 26-29
        • Griebsch I.
        • Coast J.
        • Brown J.
        Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health.
        Pediatrics. 2005; 115: e600-e614
        • Gold M.R.
        • Siegel J.E.
        • Russell L.B.
        • et al.
        Cost-effectiveness in health and medicine.
        Oxford University Press, New York1996
        • Weinstein M.C.
        • Siegel J.E.
        • Gold M.R.
        • et al.
        Recommendations of the panel on cost-effectiveness in health and medicine.
        JAMA. 1996; 276: 1253-1258
        • NICE NIFCEG
        National Institute for Clinical Excellence Guide to the Methods of Technology Appraisal.
        National Institute for Clinical Excellence, London, England2004 (London, England; 2004.)
        • Weinstein M.C.
        • Torrance G.W.
        • McGuire A.
        QALYs: the basics.
        Value Health. 2009; 12: 5-9
        • Ungar W.J.
        Economic Evaluation in Child Heath.
        Oxford University Press, New York2010
        • Brown M.M.
        • Brown G.C.
        • Sharma S.
        • et al.
        Health care economic analyses and value-based medicine.
        Surv Ophthalmol. 2003; 48: 204-223
        • Torrance G.W.
        Utility approach to measuring health-related quality of life.
        J Chronic Dis. 1987; 40: 593-603
      1. Von Neumann J, Morgenstern O. Theory of games and economic behaviors. 1944.

        • Ubel P.A.
        • Loewenstein G.
        • Jepson C.
        Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public.
        Qual Life Res. 2003; 12: 599-607
        • Grosse S.
        • Prosser L.
        • Asakawa K.
        • et al.
        QALY weights for neurosensory impairments in pediatric economic evaluations: case studies and a critique.
        Expert Rev Pharmacoecon Outcomes Res. 2010; 10: 293-308
        • Petrou S.
        • Kupek E.
        Estimating preference-based health utilities index mark 3 utility scores for childhood conditions in England and Scotland.
        Med Decis Making. 2009; 29: 291-303
        • Carroll A.E.
        • Downs S.M.
        Improving decision analyses: parent preferences (utility values) for pediatric health outcomes.
        J Pediatr. 2009; 155 (e1–5): 21-25
        • Beck J.R.
        • Pauker S.G.
        The Markov process in medical prognosis.
        Med Decis Making. 1983; 3: 419-458
        • O’Brien M.A.
        • Prosser L.A.
        • Paradise J.L.
        • et al.
        New vaccines against otitis media: projected benefits and cost-effectiveness.
        Pediatrics. 2009; 123: 1452-1463
        • McIntyre P.
        • Hall J.
        • Leeder S.
        An economic analysis of alternatives for childhood immunisation against Haemophilus influenzae type b disease.
        Aust J Public Health. 1994; 18: 394-400
        • De Wals P.
        • Petit G.
        • Erickson L.J.
        • et al.
        Benefits and costs of immunization of children with pneumococcal conjugate vaccine in Canada.
        Vaccine. 2003; 21: 3757-3764
        • Ess S.M.
        • Schaad U.B.
        • Gervaix A.
        • et al.
        Cost-effectiveness of a pneumococcal conjugate immunisation program for infants in Switzerland.
        Vaccine. 2003; 21: 3273-3281
        • Javitt J.
        • Dei Cas R.
        • Chiang Y.P.
        Cost-effectiveness of screening and cryotherapy for threshold retinopathy of prematurity.
        Pediatrics. 1993; 91: 859-866
        • Drummond M.
        • Stoddart G.
        • Torrance G.
        Methods for economic evaluation of health care programs.
        Oxford University Press, Oxford1987
        • Drummond M.F.
        Economic aspects of cataract.
        Ophthalmology. 1988; 95: 1147-1153
      2. Torrance G. Preference for health states: a review of measurement methods. In: Sinclair J, editor. Clinical and economic evaluations of perinatal programs Mead Johnson Symposium on Prenatal and Developmental Medicine, no 2. Vail, Colorado; 1982.

        • Gutierrez de Mesa E.
        • Hidalgo I.
        • Christidis P.
        • et al.
        Modeling the impact of genetic screening technologies on healthcare: theoretical model for asthma in children.
        Mol Diagn Ther. 2007; 11: 313-323
        • Brisson M.
        • Sénécal M.
        • Drolet M.
        • et al.
        Health-related quality of life lost to rotavirus-associated gastroenteritis in children and their parents: a Canadian prospective study.
        Pediatr Infect Dis J. 2010; 29: 73-75
        • Zhou F.
        • Bisgard K.M.
        • Yusuf H.R.
        • et al.
        Impact of universal haemophilus influenzae type b vaccination starting at 2 months of age in the United States: an economic analysis.
        Pediatrics. 2002; 110: 653-661
        • Bos J.M.
        • Rumke H.
        • Welte R.
        • et al.
        Epidemiologic impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands.
        Clin Ther. 2003; 25: 2614-2630
        • Cheng A.K.
        • Rubin H.R.
        • Powe N.R.
        • et al.
        Cost-utility analysis of the cochlear implant in children.
        JAMA. 2000; 284: 850-856
        • Konig H.H.
        • Barry J.C.
        Cost effectiveness of treatment for amblyopia: an analysis based on a probabilistic Markov model.
        Br J Ophthalmol. 2004; 88: 606-612
        • Carlton J.
        • Karnon J.
        • Czoski-Murray C.
        • et al.
        The clinical effectiveness and cost-effectiveness of screening programmes for amblyopia and strabismus in children up to the age of 4–5 years: a systematic review and economic evaluation.
        Health Technol Assess. 2008; 12 (iii, xi–194)
        • Coco A.S.
        Cost-effectiveness analysis of treatment options for acute otitis media.
        Ann Fam Med. 2007; 5: 29-38
        • Hong J.
        • Dilla T.
        • Arellano J.
        A modelled economic evaluation comparing atomoxetine with methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder in Spain.
        BMC Psychiatry. 2009; 9: 15
        • Goossens L.M.
        • Standaert B.
        • Hartwig N.
        • et al.
        The cost-utility of rotavirus vaccination with Rotarix (RIX4414) in the Netherlands.
        Vaccine. 2008; 26: 1118-1127
        • Standaert B.
        • Parez N.
        • Tehard B.
        • et al.
        Cost-effectiveness analysis of vaccination against rotavirus with RIX4414 in France.
        Appl Health Econ Health Policy. 2008; 6: 199-216
        • Membreno J.H.
        • Brown M.M.
        • Brown G.C.
        • et al.
        A cost-utility analysis of therapy for amblyopia.
        Ophthalmology. 2002; 109: 2265-2271
        • Briggs A.
        • Claxton K.
        • Sculpher M.
        Decision Modelling for Health Economic Evauation.
        Oxford University Press, Oxford2006
        • Barton G.R.
        • Stacey P.C.
        • Fortnum H.M.
        • et al.
        Hearing-impaired children in the United Kingdom, IV: cost-effectiveness of pediatric cochlear implantation.
        Ear Hear. 2006; 27: 575-588
        • Martin A.
        • Batty A.
        • Roberts J.A.
        • et al.
        Cost-effectiveness of infant vaccination with RIX4414 (Rotarix) in the UK.
        Vaccine. 2009; 27: 4520-4528
        • Oostenbrink R.
        • Oostenbrink J.B.
        • Moons K.G.
        • et al.
        Cost-utility analysis of patient care in children with meningeal signs.
        Int J Technol Assess Health Care. 2002; 18: 485-496
        • Brown G.C.
        • Brown M.M.
        • Sharma S.
        • et al.
        Cost-effectiveness of treatment for threshold retinopathy of prematurity.
        Pediatrics. 1999; 104: e47
        • Dunbar J.
        • Hsu V.
        • Christensen M.
        • et al.
        Cost-utility analysis of screening and laser treatment of retinopathy of prematurity.
        J AAPOS. 2009; 13: 186-190
        • King S.
        • Griffin S.
        • Hodges Z.
        • et al.
        A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents.
        Health Technol Assess. 2006; 10 (iii–iv, xiii–146)
        • Bilcke J.
        • Van Damme P.
        • Beutels P.
        Cost-effectiveness of rotavirus vaccination: exploring caregiver(s) and “no medical care” disease impact in Belgium.
        Med Decis Making. 2009; 29: 33-50
        • Chodick G.
        • Waisbourd-Zinman O.
        • Shalev V.
        • et al.
        Potential impact and cost-effectiveness analysis of rotavirus vaccination of children in Israel.
        Eur J Public Health. 2009; 19: 254-259
        • Jit M.
        • Edmunds W.J.
        Evaluating rotavirus vaccination in England and Wales. Part II. The potential cost-effectiveness of vaccination.
        Vaccine. 2007; 25: 3971-3979
        • Milne R.J.
        • Grimwood K.
        Budget impact and cost-effectiveness of including a pentavalent rotavirus vaccine in the New Zealand childhood immunization schedule.
        Value Health. 2009; 12: 888-898
        • Newall A.T.
        • Beutels P.
        • Macartney K.
        • et al.
        The cost-effectiveness of rotavirus vaccination in Australia.
        Vaccine. 2007; 25: 8851-8860
        • Konig H.H.
        • Barry J.C.
        Cost-utility analysis of orthoptic screening in kindergarten: a Markov model based on data from Germany.
        Pediatrics. 2004; 113: e95-e108
        • Prasad S.
        • Arellano J.
        • Steer C.
        • et al.
        Assessing the value of atomoxetine in treating children and adolescents with ADHD in the UK.
        Int J Clin Pract. 2009; 63: 1031-1040
        • Gilmore A.
        • Milne R.
        Methylphenidate in children with hyperactivity: review and cost-utility analysis.
        Pharmacoepidemiol Drug Saf. 2001; 10: 85-94
        • Faber A.
        • van Agthoven M.
        • Kalverdijk L.J.
        • et al.
        Long-acting methylphenidate-OROS in youths with attention-deficit hyperactivity disorder suboptimally controlled with immediate-release methylphenidate: a study of cost effectiveness in The Netherlands.
        CNS Drugs. 2008; 22: 157-170
        • O’Neill C.
        • Archbold S.M.
        • O’Donoghue G.M.
        • et al.
        Indirect costs, cost-utility variations and the funding of paediatric cochlear implantation.
        Int J Pediatr Otorhinolaryngol. 2001; 58: 53-57
        • de Lissovoy G.
        • Matza L.S.
        • Green H.
        • et al.
        Cost-effectiveness of intrathecal baclofen therapy for the treatment of severe spasticity associated with cerebral palsy.
        J Child Neurol. 2007; 22: 49-59
        • Hoving M.A.
        • Evers S.M.
        • Ament A.J.
        • et al.
        Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis.
        Dev Med Child Neurol. 2008; 50: 450-455
        • Heintz E.
        • Brodtkorb T.H.
        • Nelson N.
        • et al.
        The long-term cost-effectiveness of fetal monitoring during labour: a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone.
        BJOG. 2008; 115: 1676-1687
        • Carroll A.E.
        • Downs S.M.
        Comprehensive cost-utility analysis of newborn screening strategies.
        Pediatrics. 2006; 117: S287-S295
        • Jackson K.M.
        • Scott K.E.
        • Graff Zivin J.
        • et al.
        Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management.
        Arch Ophthalmol. 2008; 126: 493-499
        • Melliez H.
        • Levybruhl D.
        • Boelle P.Y.
        • et al.
        Cost and cost-effectiveness of childhood vaccination against rotavirus in France.
        Vaccine. 2008; 26: 706-715
        • Shim E.
        • Galvani A.P.
        Impact of transmission dynamics on the cost-effectiveness of rotavirus vaccination.
        Vaccine. 2009; 27: 4025-4030