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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Article Info
Publication History
Published online: November 11, 2011
Accepted:
September 17,
2011
Received:
January 10,
2011
Footnotes
The authors have no conflict of interest to disclose.
Identification
Copyright
© 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
