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Dalziel K, van Heusden A, Sarvananthar J, Jones R, McGregor K, Huang L, Rivero-Arias O, Herdman M, Hiscock H, Devlin N. A Qualitative Investigation to Develop an Adapted Version of the EQ-5D-Y-3L for Use in Children Aged 2-4 Years. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1525-1534. [PMID: 37348834 DOI: 10.1016/j.jval.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES Few preference-weighted health-related quality-of-life measures exist for children under 5 years of age. Young children are substantial consumers of healthcare services. This project aims to assess EQ-5D-Y-3L's appropriateness in children aged 2 to 4 years and to coproduce with parents a suitable adaptation. METHODS Purposive sampling at the Murdoch Children's Research Institute and Royal Children's Hospital was used to recruit parents or carers of children aged 2 to 4 years in Australia. Online focus groups were conducted consisting of 13 parents of healthy children, and 6 parents of children with moderate to severe health conditions. Parents provided feedback on each dimension of the proxy EQ-5D-Y-3L. Recordings were transcribed and thematic analysis was conducted. Qualitative findings guided the design of adaptations to the instrument. The adaptations were piloted to obtain feedback and refined to improve language translatability and comparability with other EuroQol instruments. RESULTS The adapted EQ-5D-Y-3L was considered generally acceptable by the parents. Parents provided a wide range of examples of how each domain related to their children, with varied examples provided across ages 2 to 4 years and health status. Additional or alternative wording was suggested by parents to improve the applicability of the instrument to this age group. One example of this was the change of the domain wording "walking about" to "movement"-ID5:"In this age group, movement is more important than walking." CONCLUSIONS The adapted EQ-5D-Y-3L has improved relevance for 2-4-year olds and appears easy to complete. Further testing of the adapted instrument is required to evaluate acceptability, reliability, and validity.
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Affiliation(s)
- Kim Dalziel
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Health Services group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Alexander van Heusden
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Janani Sarvananthar
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Renee Jones
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Health Services group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kristy McGregor
- Health Services group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Li Huang
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | | | - Harriet Hiscock
- Health Services group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nancy Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Neppelenbroek NJM, de Wit GA, Dalziel K, Devlin N, Carvalho NI. Use of Utility and Disability Weights in Economic Evaluation of Pediatric Vaccines. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1098-1106. [PMID: 36967026 DOI: 10.1016/j.jval.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/21/2023] [Accepted: 04/18/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To describe how utility weights and disability weights have been used in the context of quality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs)-based cost-effectiveness analysis (CEA) of pediatric vaccines for infectious diseases and assess the comparability between weights. METHODS A systematic review was conducted of CEAs of pediatric vaccines for 16 infectious diseases, published between January 2013 and December 2020 and using QALYs or DALYs as outcome measure. Data on values and sources of weights for the estimation of QALYs and DALYs were extracted from studies and compared across similar health states. Reporting was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Out of 2154 articles identified, 216 CEAs met our inclusion criteria. Of the included studies, 157 used utility weights and 59 used disability weights in their valuation of health states. In QALY studies, the source, background, who's preferences (adults'/children's) were applied and adjustments made to utility weights were poorly reported. In DALY studies, the Global Burden of Disease study was most often referenced. Valuation weights for similar health states varied within QALY studies and between DALY and QALY studies, but no systematic differences were identified. CONCLUSIONS This review identified considerable gaps in the way valuation weights are used and reported on in CEA. The nonstandardized use of weights may lead to different conclusions about cost-effectiveness of vaccines and policy decisions.
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Affiliation(s)
- Nienke J M Neppelenbroek
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; MSc Epidemiology Student, Utrecht University, Utrecht, The Netherlands.
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Centre for Nutrition, Prevention, and Health services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nancy Devlin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Natalie I Carvalho
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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3
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You S, Yaesoubi R, Lee K, Li Y, Eppink ST, Hsu KK, Chesson HW, Gift TL, Berruti AA, Salomon JA, Rönn MM. Lifetime quality-adjusted life years lost due to genital herpes acquired in the United States in 2018: a mathematical modeling study. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100427. [PMID: 36950038 PMCID: PMC10025423 DOI: 10.1016/j.lana.2023.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/19/2022] [Accepted: 12/26/2022] [Indexed: 02/10/2023]
Abstract
Background Genital herpes (GH), caused by herpes simplex virus type 1 and type 2 (HSV-1, HSV-2), is a common sexually transmitted disease associated with adverse health outcomes. Symptoms associated with GH outbreaks can be reduced by antiviral medications, but the infection is incurable and lifelong. In this study, we estimate the long-term health impacts of GH in the United States using quality-adjusted life years (QALYs) lost. Methods We used probability trees to model the natural history of GH secondary to infection with HSV-1 and HSV-2 among people aged 18-49 years. We modelled the following outcomes to quantify the major causes of health losses following infection: symptomatic herpes outbreaks, psychosocial impacts associated with diagnosis and recurrences, urinary retention caused by sacral radiculitis, aseptic meningitis, Mollaret's meningitis, and neonatal herpes. The model was parameterized based on published literature on the natural history of GH. We summarized losses of health by computing the lifetime number of QALYs lost per genital HSV-1 and HSV-2 infection, and we combined this information with incidence estimates to compute the total lifetime number of QALYs lost due to infections acquired in 2018 in the United States. Findings We estimated 0.05 (95% uncertainty interval (UI) 0.02-0.08) lifetime QALYs lost per incident GH infection acquired in 2018, equivalent to losing 0.05 years or about 18 days of life for one person with perfect health. The average number of QALYs lost per GH infection due to genital HSV-1 and HSV-2 was 0.01 (95% UI 0.01-0.02) and 0.05 (95% UI 0.02-0.09), respectively. The burden of genital HSV-1 is higher among women, while the burden of HSV-2 is higher among men. QALYs lost per neonatal herpes infection was estimated to be 7.93 (95% UI 6.63-9.19). At the population level, the total estimated lifetime QALYs lost as a result of GH infections acquired in 2018 was 33,100 (95% UI 12,600-67,900) due to GH in adults and 3,140 (95% UI 2,260-4,140) due to neonatal herpes. Results were most sensitive to assumptions on the magnitude of the disutility associated with post-diagnosis psychosocial distress and symptomatic recurrences. Interpretation GH is associated with substantial health losses in the United States. Results from this study can be used to compare the burden of GH to other diseases, and it provides inputs that may be used in studies on the health impact and cost-effectiveness of interventions that aim to reduce the burden of GH. Funding The Center for Disease Control and Prevention.
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Affiliation(s)
- Shiying You
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Corresponding author. Yale School of Public Health, Department of Health Policy and Management, USA.
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Kyueun Lee
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yunfei Li
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samuel T. Eppink
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine K. Hsu
- Division of Sexually Transmitted Disease Prevention & HIV/AIDS Surveillance, Massachusetts Department of Public Health, Boston, MA, USA
| | - Harrell W. Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas L. Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrés A. Berruti
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A. Salomon
- Center for Health Policy / Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Minttu M. Rönn
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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4
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Lee K, You S, Li Y, Chesson H, Gift TL, Berruti AA, Hsu K, Yaesoubi R, Salomon JA, Rönn M. Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis Acquired in the United States in 2018. Clin Infect Dis 2023; 76:e810-e819. [PMID: 35684943 PMCID: PMC9907519 DOI: 10.1093/cid/ciac427] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to estimate the health impact of syphilis in the United States in terms of the number of quality-adjusted life years (QALYs) lost attributable to infections in 2018. METHODS We developed a Markov model that simulates the natural history and management of syphilis. The model was parameterized by sex and sexual orientation (women who have sex with men, men who have sex with women [MSW], and men who have sex with men [MSM]), and by age at primary infection. We developed a separate decision tree model to quantify health losses due to congenital syphilis. We estimated the average lifetime number of QALYs lost per infection, and the total expected lifetime number of QALYs lost due to syphilis acquired in 2018. RESULTS We estimated the average number of discounted lifetime QALYs lost per infection as 0.09 (95% uncertainty interval [UI] .03-.19). The total expected number of QALYs lost due to syphilis acquired in 2018 was 13 349 (5071-31 360). Although per-case loss was the lowest among MSM (0.06), MSM accounted for 47.7% of the overall burden. For each case of congenital syphilis, we estimated 1.79 (1.43-2.16) and 0.06 (.01-.14) QALYs lost in the child and the mother, respectively. We projected 2332 (1871-28 250) and 79 (17-177) QALYs lost for children and mothers, respectively, due to congenital syphilis in 2018. CONCLUSIONS Syphilis causes substantial health losses in adults and children. Quantifying these health losses in terms of QALYs can inform cost-effectiveness analyses and can facilitate comparisons of the burden of syphilis to that of other diseases.
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Affiliation(s)
- Kyueun Lee
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shiying You
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Yunfei Li
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Harrell Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrés A Berruti
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Hsu
- Sexually Transmitted Disease Prevention & HIV/AIDS Surveillance, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joshua A Salomon
- Center for Health Policy/Center for Primary Care & Outcomes Research, Stanford University, Stanford, California, USA
| | - Minttu Rönn
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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5
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Devlin N, Roudijk B, Viney R, Stolk E. EQ-5D-Y-3L Value Sets, Valuation Methods and Conceptual Questions. PHARMACOECONOMICS 2022; 40:123-127. [PMID: 36504378 PMCID: PMC9758242 DOI: 10.1007/s40273-022-01226-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Nancy Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Bram Roudijk
- CHERE, University of Technology Sydney, Sydney, Australia
| | - Rosalie Viney
- Scientific Team, EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Elly Stolk
- CHERE, University of Technology Sydney, Sydney, Australia
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6
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Devlin NJ. Valuing Child Health Isn't Child's Play. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1087-1089. [PMID: 35667949 DOI: 10.1016/j.jval.2022.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 05/20/2023]
Affiliation(s)
- Nancy J Devlin
- Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia.
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7
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Lamb A, Murray A, Lovett R. The Challenges of Measuring and Valuing Quality of Life in Preschool Children: A Retrospective Review of NICE Appraisals. CHILDREN (BASEL, SWITZERLAND) 2021; 8:765. [PMID: 34572196 PMCID: PMC8464668 DOI: 10.3390/children8090765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
Health technology assessment agencies evaluate interventions across the lifespan. However, there is no consensus about best-practice methods to measure health-related quality of life (HRQoL) in preschool children (<5 years) and data are often scarce. We reviewed methods used to capture the HRQoL of preschool children in past National Institute for Health and Care Excellence (NICE) appraisals to establish whether there is a need for better methods in this area and if so, to identify priority research areas. We identified past NICE appraisals that included preschool children, examining the methods used to generate utility values and whether committees believed these captured HRQoL adequately. Of the 12 appraisals, most used generic HRQoL measures designed for adults. Measures were usually completed by adult patients or clinical experts. Committees frequently commented on limitations in the HRQoL data. While acknowledging that data collection may be challenging, committees would value evidence based on HRQoL data from parents or guardians collected as part of a clinical trial. We identified several research priorities including the psychometric properties of existing measures; the feasibility and validity of valuation studies; and mapping. Progress in these areas will help ensure that the aspects of HRQoL which matter to children and their families are captured in NICE evaluations.
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Affiliation(s)
- Alan Lamb
- Science Policy and Research, National Institute for Health and Care Excellence (NICE), Level 1A, City Tower, Piccadilly, Manchester M1 4BT, UK; (A.M.); (R.L.)
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8
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Carlton EF, Weiss SL, Prescott HC, Prosser LA. What's the Cost? Measuring the Economic Impact of Pediatric Sepsis. Front Pediatr 2021; 9:761994. [PMID: 34869119 PMCID: PMC8634593 DOI: 10.3389/fped.2021.761994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Sepsis, life-threatening organ dysfunction secondary to infection, hospitalizes nearly 75,000 children each year in the United States. Most children survive sepsis. However, there is increasing recognition of the longer-term consequences of pediatric sepsis hospitalization on both the child and their family, including medical, psychosocial, and financial impacts. Here, we describe family spillover effects (the impact of illness on caregivers) of pediatric sepsis, why measurement of family spillover effects is important, and the ways in which family spillover effects can be measured.
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Affiliation(s)
- Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hallie C Prescott
- Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, MI, United States.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, United States
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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9
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Rowen D, Rivero-Arias O, Devlin N, Ratcliffe J. Review of Valuation Methods of Preference-Based Measures of Health for Economic Evaluation in Child and Adolescent Populations: Where are We Now and Where are We Going? PHARMACOECONOMICS 2020; 38:325-340. [PMID: 31903522 DOI: 10.1007/s40273-019-00873-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Methods for measuring and valuing health benefits for economic evaluation and health technology assessment in adult populations are well developed. In contrast, methods for assessing interventions for child and adolescent populations lack detailed guidelines, particularly regarding the valuation of health and quality of life in these age groups. This paper critically examines the methodological considerations involved in the valuation of child- and adolescent-specific health-related quality of life by existing preference-based measures. It also describes the methodological choices made in the valuation of existing generic preference-based measures developed with and/or applied in child and adolescent populations: AHUM, AQoL-6D, CHU9D, EQ-5D-Y, HUI2, HUI3, QWB, 16D and 17D. The approaches used to value existing child- and adolescent-specific generic preference-based measures vary considerably. While the choice of whose preferences and which perspective to use is a matter of normative debate and ultimately for decision by reimbursement agencies and policy makers, greater research around these issues would be informative and would enrich these discussions. Research can also inform the other methodological choices required in the valuation of child and adolescent health states. Gaps in research evidence are identified around the impact of the child described in health state valuation exercises undertaken by adults, including the possibility of informed preferences; the appropriateness and acceptability of valuation tasks for adolescents, in particular tasks involving the state 'dead'; anchoring of adolescent preferences; and the generation and use of combined adult and adolescent preferences.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nancy Devlin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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10
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Lasseter G, Al-Janabi H, Trotter C, Carroll F, Christensen H. Understanding the role of peace of mind in childhood vaccination: A qualitative study with members of the general public. Vaccine 2020; 38:2424-2432. [DOI: 10.1016/j.vaccine.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022]
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11
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Otero HJ, Degnan AJ, Kadom N, Neumann PJ, Lavelle TA. Cost-Effectiveness Analysis in Pediatric Imaging: The Evidence (or Lack Thereof) Thus Far. J Am Coll Radiol 2019; 17:452-461. [PMID: 31790678 DOI: 10.1016/j.jacr.2019.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review all published cost-effectiveness analyses (CEAs) of imaging technologies in children. METHODS We identified all CEAs involving fetal and pediatric imaging included in a publicly available repository of CEAs published since 1976. Information on publication characteristics, methods, costs, quality of life weights, and incremental cost-effectiveness ratios (ICERs) was recorded for each article. RESULTS Of 480 diagnostic CEAs, only 10 focused on fetal and pediatric imaging. The 10 studies reported 43 quality of life weights based on previously published adult data (n = 20, 46.5%); pregnant women perspective (n = 11, 25.6%), and treating physician perspective (n = 12, 27.9%). None of the studies elicited quality of life weights from children nor took into consideration the postnatal impact of disease on family's quality of life. All studies used a health care payer perspective without incorporating patients' incurred cost such as loss wages or travel related cost. Of 37 ICERs, 7 (18.9%) were cost saving and 6 (16.2%) were more expensive and less effective. The remaining ICERs ranged from $1,400 per quality-adjusted life-year (MRI versus ultrasound in newborns with moderate risk of occult spinal dysraphism) to $10,000,000 per quality-adjusted life-year (CT versus no imaging in children at low risk for craniosynostosis). CONCLUSION There is a striking paucity of cost-effectiveness studies evaluating imaging technologies in children. Existing studies do not incorporate the patient and family perspectives regarding utilities (eg, impact of child's disease on families' quality of life) or cost (eg, loss wages, travel, time off). Future studies should elicit and incorporate the impact of disease on families to better reflect real-world scenarios.
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Affiliation(s)
- Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta (Egleston), Atlanta, Georgia
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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12
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Brown V, Tan EJ, Hayes AJ, Petrou S, Moodie ML. Utility values for childhood obesity interventions: a systematic review and meta-analysis of the evidence for use in economic evaluation. Obes Rev 2018; 19:905-916. [PMID: 29356315 DOI: 10.1111/obr.12672] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/12/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
Rigorous estimates of preference-based utilities are important inputs into economic evaluations of childhood obesity interventions, yet no published review currently exists examining utility by weight status in paediatric populations. A comprehensive systematic literature review and meta-analysis was therefore undertaken, pooling data on preference-based health state utilities by weight status in children using a random-effects model. Tests for heterogeneity were performed, and publication bias was assessed. Of 3,434 potentially relevant studies identified, 11 met our eligibility criteria. Estimates of Cohen's d statistic suggested a small effect of weight status on preference-based utilities. Mean utility values were estimated as 0.85 (95% uncertainty interval [UI] 0.84-0.87), 0.83 (95% UI 0.81-0.85), 0.82 (95% UI 0.79-0.84) and 0.83 (95% UI 0.80-0.86) for healthy weight, overweight, obese and overweight/obese states, respectively. Meta-analysis of studies reporting utility values for both healthy weight and overweight/obese participants found a statistically significant weighted mean difference (0.015, 95% UI 0.003-0.026). A small but statistically significant difference was also estimated between healthy weight and overweight participants (0.011, 95% UI 0.004-0.018). Study findings suggest that paediatric-specific benefits of obesity interventions may not be well reflected by available utility measures, potentially underestimating cost-effectiveness if weight loss in childhood/adolescence improves health or well-being.
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Affiliation(s)
- V Brown
- Deakin Health Economics, Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - E J Tan
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A J Hayes
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - S Petrou
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Warwick Medical School, University of Warwick, Coventry, UK
| | - M L Moodie
- Deakin Health Economics, Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
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13
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Cataldi JR, Dempsey AF, Allison MA, O'Leary ST. Impact of publicly available vaccination rates on parental school and child care choice. Vaccine 2018; 36:4525-4531. [PMID: 29909131 DOI: 10.1016/j.vaccine.2018.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/21/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Several states require schools and child cares to report vaccination rates, yet little is known about the impact of these policies. Our objectives were to assess: (1) predicted impact of vaccination rates on school/child care choice, (2) differences between vaccine hesitant and non-hesitant parents, and (3) differences by child's age. METHODS In 2016, a cross-sectional email survey of Colorado mothers with children ≤12 years old assessed value of vaccination rates in the context of school/child care choice. A willingness-to-pay framework measured preference for schools/child cares with different vaccination rates using tradeoff with commute time. RESULTS Response rate was 42% (679/1630). Twelve percent of respondents were vaccine hesitant. On a scale where 1 is "not important at all" and 4 is "very important" parents rated the importance of vaccination rates at 3.08. Respondents (including vaccine-hesitant respondents) would accept longer commutes to avoid schools/child cares with lower vaccination rates. Parents of child-care-age children were more likely to consider vaccination rates important. CONCLUSIONS This study shows parents highly value vaccination rates in the context of school and child care choice. Both hesitant and non-hesitant parents are willing to accept longer commute times to protect their children from vaccine-preventable diseases.
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Affiliation(s)
- Jessica R Cataldi
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| | - Amanda F Dempsey
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, 13199 East Montview Blvd, Aurora, CO 80045, USA.
| | - Mandy A Allison
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, 13199 East Montview Blvd, Aurora, CO 80045, USA.
| | - Sean T O'Leary
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, 13199 East Montview Blvd, Aurora, CO 80045, USA.
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The impact of influenza on the health related quality of life in China: an EQ-5D survey. BMC Infect Dis 2017; 17:686. [PMID: 29037172 PMCID: PMC5644056 DOI: 10.1186/s12879-017-2801-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Influenza causes considerable morbidity and mortality in China, but its impact on the health-related quality of life (HRQoL) has not been previously measured. METHODS We conducted a retrospective telephone survey to assess the impact of influenza on the HRQoL among outpatients and inpatients using the EuroQoL EQ-5D-3 L instrument. Participants were individuals with laboratory-confirmed influenza infection registered by the National Influenza-like-illness Surveillance Network in 2013. RESULTS We interviewed 839 of 11,098 eligible influenza patients. After excluding those who were unable to complete the HRQoL for the registered influenza episode, 778 patients were included in the analysis. Both outpatients (n = 529) and inpatients (n = 249) most commonly reported problems with pain/discomfort (71.8% of outpatients and 71.9% of inpatients) and anxiety/depression (62.0% of outpatients and 75.1% of inpatients). For individual influenza outpatients, the mean health utility was 0.6142 (SD 0.2006), and the average quality adjusted life days (QALD) loss was 1.62 (SD 1.84) days. The HRQoL of influenza inpatients was worse (mean health utility 0.5851, SD 0.2197; mean QALD loss 3.51 days, SD 4.25) than that of outpatients (p < 0.05). The presence of underlying medical conditions lowered the HRQoL for both outpatients and inpatients (p < 0.05). CONCLUSIONS Influenza illness had a substantial impact on HRQoL. QALD loss due to an acute influenza episode in younger children was comparable to that due to enterovirus A71-associated hand, foot and mouth disease. Our findings are key inputs into disease burden estimates and cost-effectiveness evaluations of influenza-related interventions in China.
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Zheng Y, Jit M, Wu JT, Yang J, Leung K, Liao Q, Yu H. Economic costs and health-related quality of life for hand, foot and mouth disease (HFMD) patients in China. PLoS One 2017; 12:e0184266. [PMID: 28934232 PMCID: PMC5608208 DOI: 10.1371/journal.pone.0184266] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 08/21/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) is a common illness in China that mainly affects infants and children. The objective of this study is to assess the economic cost and health-related quality of life associated with HFMD in China. METHOD A telephone survey of caregivers were conducted in 31 provinces across China. Caregivers of laboratory-confirmed HFMD patients who were registered in the national HFMD enhanced surveillance database during 2012-2013 were invited to participate in the survey. Total costs included direct medical costs (outpatient care, inpatient care and self-medication), direct non-medical costs (transportation, nutrition, accommodation and nursery), and indirect costs for lost income associated with caregiving. Health utility weights elicited using EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS) were used to calculate associated loss in quality adjusted life years (QALYs). RESULTS The subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170 severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild inpatients, severe cases and fatal cases were $201 (95%CI $187, $215), $1072 (95%CI $999, $1144), $3051 (95%CI $2905, $3197) and $2819 (95%CI $2068, $3571) respectively. The mean QALY losses per HFMD episode for mild outpatients, mild inpatients and severe cases were 3.6 (95%CI 3.4, 3,9), 6.9 (95%CI 6.4, 7.4) and 13.7 (95%CI 12.9, 14.5) per 1000 persons. Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and QALY loss. CONCLUSION HFMD poses a high economic and health burden in China. Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China.
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Affiliation(s)
- Yaming Zheng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph T. Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Juan Yang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kathy Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qiaohong Liao
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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Nerich V, Saing S, Gamper EM, Holzner B, Pivot X, Viney R, Kemmler G. Critical appraisal of health-state utility values used in breast cancer-related cost–utility analyses. Breast Cancer Res Treat 2017; 164:527-536. [DOI: 10.1007/s10549-017-4283-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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