Skip to main content
SpringerLink
Log in

Valuing Children’s Health

A Comparison of Cost-Utility Analyses for Adult and Paediatric Health Interventions in the US

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

The objective of this review was to analyse the methods of paediatric and adult cost-utility analyses (CUAs) conducted in US populations, and to compare the cost-utility ratios of health interventions by classifying them by disease prevention stage, intervention category and primary disease type. A CUA database developed by the Tufts-New England Medical Center, Boston, MA, USA was used to compare the descriptive and methodological characteristics of paediatric and adult studies.

The final dataset included 35 paediatric and 491 adult studies, which generated a total of 91 paediatric and 1498 adult cost-utility ratios. In paediatric studies, the most common intervention types were immunisations and pharmaceutical interventions, which each accounted for 17% of studies. Pharmaceutical interventions accounted for the plurality of adult studies (36%). In studies that used a single source of preferences to determine quality-of-life weights, preferences most frequently came from the author in paediatric studies (29%) and the patient in adult studies (14%). Almost all studies with available discount rate data used the same rate (most commonly 3%) for costs and benefits. Few studied used generic health-state classification instruments; preferences for health states were most often based on author and community preferences in paediatric studies, and author and patient preferences in adult studies. The overall median cost-utility ratio was $US7300/QALY (year 2002 values) in child studies and $US26 000/QALY in adult studies; child studies tended to have lower published cost-utility ratios than adult studies, even when categorised according to intervention or disease.

In conclusion, CUAs of paediatric and adult health interventions vary across descriptive characteristics, but are largely similar methodologically. Further, costutility ratios for interventions evaluated in the literature tend to be lower for paediatric interventions than for adult ones. When allocating resources, policy makers who use economic analysis as a decision-making aid can take some comfort in the methodological similarities between paediatric and adult studies, but more work is required to standardise methods in both groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I
Table II
Table III
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Gold MR, Siegel IE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996

    Google Scholar 

  2. Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. New York: Oxford University Press, 1997

    Google Scholar 

  3. Neumann PJ, Sandberg EA, Bell CM, et al. Are pharmaceuticals cost-effective? A review of the evidence. Health Aff 2005; 19 (2): 92–109

    Article  Google Scholar 

  4. Neumann PJ, Greenberg D, Olchanski NV, et al. Growth and quality of the cost-utility literature, 1976–2001. Value Health 2005; 8 (1): 3–9

    Article  PubMed  Google Scholar 

  5. Neumann PJ, Rosen AB, Weinstein MC. Medicare and cost-effectiveness analysis. New Engl J Med 2005; 353: 1516–1522

    Article  PubMed  CAS  Google Scholar 

  6. Stone PW, Teutsch S, Chapman RH, et al. Cost-utility analyses of clinical preventive services: published ratios, 1976–1997. Am J Prev Med 2000; 19 (1): 15–23

    Article  PubMed  CAS  Google Scholar 

  7. Stone PW, Schackman BR, Neukermans CP, et al. A synthesis of cost-utility analysis literature in infectious disease. Lancet Infect Dis 2005; 5: 383–391

    Article  PubMed  Google Scholar 

  8. Brauer CA, Olchanski NV, Rosen AB, et al. Cost-utility analyses in orthopedic surgery. J Bone Joint Surg (Am) 2005; 87 (6): 1253–1259

    Article  Google Scholar 

  9. Chapman RH, Berger M, Weinstein MC, et al. When does quality-adjusting life-years matter in cost-effectiveness analysis? Health Econ 2004; 13 (5): 429–436

    Article  PubMed  Google Scholar 

  10. Earle CC, Chapman RH, Baker CS, et al. Systematic overview of cost-utility assessments in oncology. J Clin One 2000; 18: 3302–3317

    CAS  Google Scholar 

  11. Pirraglia PA, Rosen AB, Hermann RC, et al. Cost utility analysis studies of depression management: a systematic review. Am J Psychiatry 2004; 161 (12): 2155–2162

    Article  PubMed  Google Scholar 

  12. Petrou P. Methodological issues raised by preference-based approaches to measuring the health status of children. Health Econ 2003; 12 (8): 697–702

    Article  PubMed  Google Scholar 

  13. Matza LS, Swensen AR, Flood EM, et al. Assessment of health-related quality of life in children: a review of conceptual, methodological, and regulatory issues. Value Health 2004; 7 (1): 79–92

    Article  PubMed  Google Scholar 

  14. Keren R, Pati S, Feudtner C. The generation gap: differences between children and adults pertinent to economic evaluations of health interventions. Pharmacoeconomics 2004; 22 (2): 71–81

    Article  PubMed  Google Scholar 

  15. 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 (5): e600–e608

    Article  PubMed  Google Scholar 

  16. Tilford JM. Cost-effectiveness analysis and emergency medical services for children: issues and applications. Ambul Pediatr 2002; 2 (4 Suppl.): 330–336

    Article  PubMed  Google Scholar 

  17. Ungar WJ, Santos MT. The quality of pediatric health economic evaluations. Int J Technol Assess Health Care 2005; 21 (2): 203–210

    PubMed  Google Scholar 

  18. Chapman RH, Stone PW, Sandberg EA, et al. A comprehensive league table of cost-utility ratios and a subtable of ‘panel-worthy’ studies. Med Decis Making 2000; 20: 451–467

    Article  PubMed  CAS  Google Scholar 

  19. Tufts-New England Medical Center. Center for the Evaluation of Value and Risk In Health. Cost-effectiveness analysis registry [online]. Available from URL: http://www.tufts-nemc.org/cearegistry [Accessed 2007 Jan 11]

  20. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (1): 159–174

    Article  PubMed  CAS  Google Scholar 

  21. Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996

    Google Scholar 

  22. Bala MV, Wood LL, Zarkin GA, et al. Are health states ‘timeless’? The case of the standard Gamble method. J Clin Epidemiol 1999; 52 (11): 1047–1053

    Article  PubMed  CAS  Google Scholar 

  23. Ungar WJ, Santos MT. Trends in paediatric health economic evaluation: 1980 to 1999. Arch Dis Child 2004; 89 (1): 26–29

    PubMed  CAS  Google Scholar 

  24. Ungar WJ, Santos MT. The Pediatric Economic Database Evaluation (PEDE) project: establishing a database to study trends in pediatric economic evaluation. Med Care 2003; 41 (10): 1142–1152

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding for this study was provided through the Harvard Pilgrim Health Care Foundation Faculty Grants programme. We would like to thank Ken Kleinman for his helpful comments on our statistical analysis. We also thank Jenny Palmer for her help in acquiring the data used in this review, and Tracy Lieu and Grace Lee for providing comments on earlier drafts of the manuscript. Readers that contributed to the construction of the registry are acknowledged on the website. Any errors or omissions are the sole responsibility of the authors. Joseph Ladapo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Harvard Medical School and Harvard Graduate School of Arts and Sciences, Boston, Massachusetts, USA

    Joseph A. Ladapo

  2. Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, Massachusetts, USA

    Peter J. Neumann

  3. Department of Pediatrics, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Ron Keren

  4. School of Medicine, Division of General Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Ron Keren

  5. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Center for Child Health Care Studies, Boston, 133 Brookline Ave, 6th floor, Massachusetts, 02215, USA

    Lisa A. Prosser

Authors
  1. Joseph A. Ladapo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter J. Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ron Keren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa A. Prosser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa A. Prosser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ladapo, J.A., Neumann, P.J., Keren, R. et al. Valuing Children’s Health. Pharmacoeconomics 25, 817–828 (2007). https://doi.org/10.2165/00019053-200725100-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200725100-00002

Keywords

Search

Navigation