Elsevier

Value in Health

Volume 23, Issue 7, July 2020, Pages 907-917
Value in Health

Methodology
A Review of the Methods Used to Generate Utility Values in NICE Technology Assessments for Children and Adolescents

https://doi.org/10.1016/j.jval.2020.02.011Get rights and content
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Highlights

  • There is little guidance or recommendations around the methods for generating health state utility values for children and adolescents in cost-effectiveness analysis.

  • This review examines previous National Institute of Health and Care Excellence technology appraisals to identify the methods used to generate utility values for child and adolescent health states.

  • The review finds that most assessments (33 of 40) that made recommendations about children involved the use of adult EQ-5D, and few used a child- or adolescent-specific preference-based measure (10 of 40).

  • In most of the assessments that incorporated the child-to-adult transition (n = 14), children and adolescents had the same utility values for event states as adults, and the utility values were estimated using EQ-5D completed by adults.

Abstract

Objective

This review summarizes and critically examines methods used to generate utilities for child and adolescent health states in previous National Institute for Health and Care Excellence (NICE) technology assessments (TA) and highly specialized technology (HST) evaluations.

Methods

We identified all NICE TA and HST evaluations in which the licensed indication for the technology included people younger than 18 and included in the review all evaluations using a cost-utility analysis.

Results

The review includes 40 TA and HST evaluations. Most assessments generated utility values with the EQ-5D scored using the adult version of the EQ-5D either exclusively (n = 16) or alongside other utility measures and direct elicitation methods of patient own utility (n = 17), although 7 did not use the EQ-5D. Eight assessments used both the EQ-5D child- and adolescent-specific preference-based measures: Health Utilities Index Mark 2 (n = 6), child- and adolescent-specific preference-based measure for atopic dermatitis (n = 1), and youth version of the EQ-5D (EQ-5D-Y) valued using the adult EQ-5D value set (n = 1) or generated using mapping and valued using the adult EQ-5D value set (n = 2). Some cost-utility analyses used age adjustment (utility subtractions, weights, and published mapping formulae) from the adult EQ-5D UK population norms to reflect the general population or disease-free health for children and adolescents (n = 9), and 1 assessment assumed full health (utility value of 1).

Conclusion

The review found limited use of child and adolescent population-specific measures to generate health state utility values for children and adolescents in NICE technology assessments. Often assessments involve the use of an adult-specific measure to reflect the health of children.

Keywords

adolescents
children
health state utility values
QALYs
technology appraisals

Cited by (0)

Author Contributions: Concept and design: Hill, Wong, Rowen, Wailoo, Pennington.

Analysis and interpretations of data: Rowen, Wailoo, Pennington.

Drafting of the manuscript: Hill, Wong, Rowen, Wailoo, Pennington.

Critical revision of the paper for important intellectual content: Hill, Wong, Rowen, Wailoo, Pennington.

Obtaining funding: Wailoo.

Supervision: Wailoo.

Conflict of Interest Disclosures: Drs Rowen and Wailoo reported receiving grants from the National Institute for Health and Care Excellence during the conduct of the study. No other disclosures were reported.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.