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Husbands S, Mitchell PM, Kinghorn P, Byford S, Breheny K, Bailey C, Anand P, Peters TJ, Floredin I, Coast J. The development of a capability wellbeing measure in economic evaluation for children and young people aged 11-15. Soc Sci Med 2024; 360:117311. [PMID: 39276395 DOI: 10.1016/j.socscimed.2024.117311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 09/06/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024]
Abstract
The capability approach provides a broad evaluative space for making funding decisions for health and care interventions, with capability wellbeing as the outcome of value. A range of capability measures have been developed for the economic evaluation of health and care interventions for adults. However, such measures have not been previously developed for children and young people for this purpose and may be valuable. This study aimed to identify important capabilities for children and young people aged 11-15, and to develop these into attributes for an economic measure that can inform funding decisions. Thirty-three qualitative in-depth interviews were undertaken with children and young people aged 11-15 (n = 19) and parents (n = 14) in urban and rural areas of England between September 2019 and November 2021. Purposeful maximum variation sampling ensured representation from different backgrounds. Children and young people were asked to think of things important to them and place these on sticky notes around a drawing/photograph of themselves; the interview asked them about these important things. Parents were asked to identify factors that enhanced and negatively impacted their child's quality of life. Analysis using constant comparison facilitated exploration of similarities and differences in important capabilities. A second phase of semi-structured interviews with children and young people (n = 15) explored how these attributes should be expressed in a meaningful way. Eight overarching capability wellbeing themes were identified, with some variation across children and young people, and parent groups: Fun and enjoyment; Learning and experiencing; Attachment; Emotional security andsupport; Achievement; Identity and choice; Physical safety; Aspiration. Potentially, this information will help to provide an alternative approach to the measurement of benefits to children and young people for economic evaluation of health and care interventions, one that will be better able to capture benefits associated with interventions to improve the social determinants of health.
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Affiliation(s)
- Samantha Husbands
- Health Economics & Health Policy (HEHP@Bristol), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Paul Mark Mitchell
- Health Economics & Health Policy (HEHP@Bristol), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Katie Breheny
- Health Economics & Health Policy (HEHP@Bristol), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Cara Bailey
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Paul Anand
- Economics, The Open University, Department of Social Policy and Intervention, Oxford University, Oxford, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, and Bristol Dental School, University of Bristol, Bristol, BS1 2LY, UK
| | - Isabella Floredin
- Health Economics & Health Policy (HEHP@Bristol), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Joanna Coast
- Health Economics & Health Policy (HEHP@Bristol), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK.
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Flood C, Hirani SP, Mulligan K, Taylor J, Harris S, Wedderburn LR, Newman SP. Economic evaluation of a trial exploring the effects of a web-based support tool for parents of children with juvenile idiopathic arthritis. Rheumatology (Oxford) 2024; 63:SI136-SI142. [PMID: 38519117 PMCID: PMC11381677 DOI: 10.1093/rheumatology/keae188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To explore the cost-effectiveness of a web-based support tool for parents of children with Juvenile idiopathic arthritis. METHODS A multi-centred randomized controlled trial was conducted in paediatric rheumatology centres in England. The WebParC intervention consisted of online information about JIA and its treatment and a toolkit using cognitive-behavioural therapy principles to support parents manage their child's JIA. An economic evaluation was performed alongside the trial involving 220 parents. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress, with two dimensions: difficulty and frequency. These measures along with costs were assessed post intervention at 4 and 12 months. Costs were calculated for healthcare usage using a UK NHS economic perspective. Data was collected and analysed on the impact of caring costs on families. Uncertainty around cost-effectiveness was explored using bootstrapping and cost-effectiveness acceptability curves. RESULTS The intervention arm showed improved average Pediatric Inventory for Parents scores for the dimensions of frequency and difficulty, of 1.5 and 3.6 respectively at 4 months and 0.35 and 0.39 at 12 months, representing improved PIP scores for the intervention arm. At both 4 and 12 month follow-up, the average total cost per case was higher in the control group when compared with the intervention arm with mean differences of £360 (95% CI £29.6 to £691) at 4 months and £203 (95% CI £16 to £390) at 12 months. The probability of the intervention being cost-effective ranged between 49% and 54%. CONCLUSION The WebParC intervention led to reductions in primary and secondary healthcare resource use and costs at 4 and 12 months. The intervention demonstrated particular savings for rheumatology services at both follow-ups. Future economies of scale could be realised by health providers with increased opportunities for cost-effectiveness over time. TRIAL REGISTRATION ISRCTN, ISRCTN13159730.
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Affiliation(s)
- Chris Flood
- Institute of Health and Social Care, London South Bank University, London, UK
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Kathleen Mulligan
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Jo Taylor
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Sally Harris
- University Hospitals Sussex NHS Trust, Brighton, UK
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at University College London Great Ormond Street Institute of Child Health, University College London, London, UK
- National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Stanton P Newman
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, UK
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Gong H, Ong SC, Li F, Shen Y, Weng Z, Zhao K, Jiang Z, Wang M. Cost-effectiveness of immune checkpoint inhibitors as a first-line therapy for advanced hepatocellular carcinoma: a systematic review. HEALTH ECONOMICS REVIEW 2024; 14:48. [PMID: 38967718 PMCID: PMC11225220 DOI: 10.1186/s13561-024-00526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
Since 2017, immune checkpoint inhibitors (ICIs) have been available for the treatment of advanced hepatocellular carcinoma (HCC) or unresectable HCC, but their adoption into national medical insurance programs is still limited. Cost-effectiveness evidence can help to inform treatment decisions. This systematic review aimed to provide a critical summary of economic evaluations of ICIs as a treatment for advanced HCC and identify key drivers (PROSPERO 2023: CRD42023417391). The databases used included Scopus, Web of Science, PubMed, Embase, and Cochrane Central. Economic evaluations of ICIs for the treatment of advanced HCC were included. Studies were screened by two people. Of the 898 records identified, 17 articles were included. The current evidence showed that ICIs, including atezolizumab plus bevacizumab, sintilimab plus bevacizumab/bevacizumab biosimilar, nivolumab, camrelizumab plus rivoceranib, pembrolizumab plus lenvatinib, tislelizumab, durvalumab, and cabozantinib plus atezolizumab, are probably not cost-effective in comparison with tyrosine kinase inhibitors or other ICIs. The most influential parameters were price of anticancer drugs, hazard ratios for progression-free survival and overall survival, and utility for health statest. Our review demonstrated that ICIs were not a cost-effective intervention in advanced HCC. Although ICIs can significantly enhance the survival of patients with advanced HCC, decision-makers should consider the findings of economic evaluations and affordability before adoption of new therapies.
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Affiliation(s)
- Hongyu Gong
- Incubation Center for Scientific and Technological Achievements, Kunming Medical University, Chunrong west road 1168, Kunming City, China
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM Penang, Penang City, Malaysia
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM Penang, Penang City, Malaysia.
| | - Fan Li
- Incubation Center for Scientific and Technological Achievements, Kunming Medical University, Chunrong west road 1168, Kunming City, China
- Yunnan Drug Policy Research Center, Kunming Medical University, Kunming, China
| | - Yan Shen
- Gastroenterology Oncology, Yunnan Cancer Hospital, Kunzhou Road 519, Kunming City, China
| | - Zhiying Weng
- School of Pharmaceutical Science &Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Chunrong west road 1168, Kunming City, China
| | - Keying Zhao
- School of Public Health, Kunming Medical University, Chunrong West Road 1168, Kunming City, China
| | - Zhengyou Jiang
- School of Management, Universiti Sains Malaysia, 11800 USM Penang, Penang City, Malaysia
| | - Meng Wang
- Physical Examination Center, Kunming Center for Disease Prevention and Control, Xichang Road 126, Kunming City, China
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Mascarenhas E, Miguel LS, Oliveira MD, Fernandes RM. Economic evaluations of medical devices in paediatrics: a systematic review and a quality appraisal of the literature. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:33. [PMID: 38678250 PMCID: PMC11056067 DOI: 10.1186/s12962-024-00537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Although economic evaluations (EEs) have been increasingly applied to medical devices, little discussion has been conducted on how the different health realities of specific populations may impact the application of methods and the ensuing results. This is particularly relevant for pediatric populations, as most EEs on devices are conducted in adults, with specific aspects related to the uniqueness of child health often being overlooked. This study provides a review of the published EEs on devices used in paediatrics, assessing the quality of reporting, and summarising methodological challenges. METHODS A systematic literature search was performed to identify peer-reviewed publications on the economic value of devices used in paediatrics in the form of full EEs (comparing both costs and consequences of two or more devices). After the removal of duplicates, article titles and abstracts were screened. The remaining full-text articles were retrieved and assessed for inclusion. In-vitro diagnostic devices were not considered in this review. Study descriptive and methodological characteristics were extracted using a structured template. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist was used to assess the quality of reporting. A narrative synthesis of the results was conducted followed by a critical discussion on the main challenges found in the literature. RESULTS 39 full EEs were eligible for review. Most studies were conducted in high-income countries (67%) and focused on high-risk therapeutic devices (72%). Studies comprised 25 cost-utility analyses, 13 cost-effectiveness analyses and 1 cost-benefit analysis. Most of the studies considered a lifetime horizon (41%) and a health system perspective (36%). Compliance with the CHEERS 2022 items varied among the studies. CONCLUSIONS Despite the scant body of evidence on EEs focusing on devices in paediatrics results highlight the need to improve the quality of reporting and advance methods that can explicitly incorporate the multiple impacts related to the use of devices with distinct characteristics, as well as consider specific child health realities. The design of innovative participatory approaches and instruments for measuring outcomes meaningful to children and their families should be sought in future research.
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Affiliation(s)
- Edgar Mascarenhas
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisboa, Portugal.
| | - Luís Silva Miguel
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mónica D Oliveira
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisboa, Portugal
- iBB- Institute for Bioengineering and Biosciences and i4HB- Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Ricardo M Fernandes
- Laboratório de Farmacologia e Terapêutica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departmento de Pediatria, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Matza LS, Stewart KD, Fournier M, Rowen D, Lachmann R, Scarpa M, Mengel E, Obermeyer T, Ayik E, Laredo F, Pulikottil-Jacob R. Assessment of health state utilities associated with adult and pediatric acid sphingomyelinase deficiency (ASMD). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01667-7. [PMID: 38409492 DOI: 10.1007/s10198-023-01667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/21/2023] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Acid sphingomyelinase deficiency (ASMD) type B is a rare genetic disorder leading to enlargement of the spleen and liver, pulmonary dysfunction, and other symptoms. Cost-utility analyses are often conducted to quantify the value of new treatments, and these analyses require health state utilities. Therefore, the purpose of this study was to estimate utilities associated with varying levels of severity of adult and pediatric ASMD type B. METHODS Seven adult and seven child health state vignettes describing ASMD were developed based on published literature, clinical trial results, and interviews with clinicians, patients with ASMD, and parents of children with ASMD. The health states were valued in time trade-off interviews with adult general population respondents in the UK. RESULTS Interviews were completed with 202 participants (50.0% female; mean age = 41.3 years). The health state representing ASMD without impairment had the highest mean utility for both the adult and child health states (0.92/0.94), and severe ASMD had the lowest mean utility (0.33/0.45). Every child health state had a significantly greater utility than the corresponding adult health state. Differences between adult/child paired states ranged from 0.02 to 0.13. Subgroup analyses explored the impact of parenting status on valuation of child health states. DISCUSSION Greater severity of ASMD was associated with lower mean utility. Results have implications for valuation of pediatric health states. The resulting utilities may be useful in cost-utility modeling estimating the value of treatment for ASMD.
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Affiliation(s)
- Louis S Matza
- Patient-Centered Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | - Katie D Stewart
- Patient-Centered Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | | | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Maurizio Scarpa
- Centro Coordinamento Regionale Malattie Rare, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Eugen Mengel
- SphinCS-Institute of Clinical Science for Lysosomal Storage Diseases, Hochheim, Germany
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Thai TTH, Engel L, Perez JK, Tan EJ, Eades S, Sanci L, Mihalopoulos C. A systematic review of health state utility values and psychometric performance of generic preference-based instruments for children and adolescents with mental health problems. Qual Life Res 2023; 32:3005-3026. [PMID: 37237136 PMCID: PMC10522744 DOI: 10.1007/s11136-023-03441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
AIMS This paper aims to systematically identify reported health state utility values (HSUVs) in children and adolescents with mental health problems (MHPs) aged less than 25 years; to summarise the techniques used to elicit HSUVs; and to examine the psychometric performance of the identified multi-attribute utility instruments (MAUIs) used in this space. METHODS A systematic review was conducted following PRISMA guidelines. Peer-reviewed studies published in English, reporting HSUVs for children and adolescents with MHPs using direct or indirect valuation methods were searched in six databases. RESULTS We found 38 studies reporting HSUVs for 12 types of MHPs across 12 countries between 2005 and October 2021. Attention deficit hyperactivity disorder (ADHD) and depression are the most explored MHPs. Disruptive Behaviour Disorder was associated with the lowest reported HSUVs of 0.06 while cannabis use disorder was associated with the highest HSUVs of 0.88. Indirect valuation method through the use of MAUIs (95% of included studies) was the most frequently used approach, while direct valuation methods (Standard Gamble, Time Trade-Off) were only used to derive HSUVs in ADHD. This review found limited evidence of the psychometric performance of MAUIs used in children and adolescents with MHPs. CONCLUSION This review provides an overview of HSUVs of various MHPs, the current practice to generate HSUVs, and the psychometric performance of MAUIs used in children and adolescents with MHPs. It highlights the need for more rigorous and extensive psychometric assessments to produce evidence on the suitability of MAUIs used in this area.
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Affiliation(s)
- Thao T H Thai
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Joahna Kevin Perez
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Eng Joo Tan
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 780 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 780 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Devlin NJ, Pan T, Sculpher M, Jit M, Stolk E, Rowen D, van Hout B, Norman R. Using Age-Specific Values for Pediatric HRQoL in Cost-Effectiveness Analysis: Is There a Problem to Be Solved? If So, How? PHARMACOECONOMICS 2023; 41:1165-1174. [PMID: 37439998 PMCID: PMC10492668 DOI: 10.1007/s40273-023-01300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/14/2023]
Abstract
Value sets for the EQ-5D-Y-3L published to date appear to have distinctive characteristics compared with value sets for corresponding adult instruments: in many cases, the value for the worst health state is higher and there are fewer values < 0. The aim of this paper is to consider how and why values for child and adult health differ; and what the implications of that are for the use of EQ-5D-Y-3L values in economic evaluations to inform healthcare resource allocation decisions. We posit four potential explanations for the differences in values: (a) The wording of severity labels may mean the worst problems on the EQ-5D-Y-3L are descriptively less severe than those on the EQ-5D-5L; (b) Adults may genuinely consider that children are less badly affected than adults by descriptively similar health issues. That is, for any given health problem, adult respondents in valuation studies consider children's overall health-related quality of life (HRQoL) on average to be higher than that for adults; (c) Values are being sought by eliciting adults' stated preferences for HRQoL in another person, rather than in themselves (regardless of whether the 'other person' concerned is a child); and (d) The need to elicit preferences for child HRQoL that are anchored at dead = 0 invokes special considerations regarding children's survival. Existing evidence does not rule out the possibility that (c) and (d) exert an upward bias in values. We consider the implications of that for the interpretation and use of values for pediatric HRQoL. Alternative methods for valuing children's HRQoL in a manner that is not 'age specific' are possible and may help to avoid issues of non-comparability. Use of these methods would place the onus on health technology assessment bodies to reflect any special considerations regarding child quality-adjusted life-year gains.
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Affiliation(s)
- Nancy J Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, VIC, 3010, Australia.
| | - Tianxin Pan
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, VIC, 3010, Australia
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Barend van Hout
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
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Sharma D, Prinja S, Aggarwal AK, Rajsekar K, Bahuguna P. Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 16:100241. [PMID: 37694178 PMCID: PMC10485782 DOI: 10.1016/j.lansea.2023.100241] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 09/12/2023]
Abstract
Background Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Methods Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. Findings The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. Interpretation The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. Funding This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India.
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Affiliation(s)
- Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun K. Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Hausman DM. Eliciting preferences and respecting values: Why ask? Soc Sci Med 2023; 320:115711. [PMID: 36773532 DOI: 10.1016/j.socscimed.2023.115711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
This essay explores the pitfalls and ambiguities in relying on preference elicitation to value health states, and it distinguishes preference elicitation, as a fallible method of measuring well-being, from public consultation, as an element of public deliberation. After distinguishing preference elicitation as a method of ascertaining opinions from preference elicitation as a method of measuring well-being, it points out that preferences depend on beliefs and the considerations speaking in favor of deferring to people's values do not carry over to deferring to their beliefs. Instead of valuing health states by their bearing on well-being, as measured by preferences, this essay argues for valuing health states by their bearing on activity limitations and suffering, as determined by public deliberation.
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Getaneh AM, Li X, Mao Z, Johannesen CK, Barbieri E, van Summeren J, Wang X, Tong S, Baraldi E, Phijffer E, Rizzo C, van Wijhe M, Heikkinen T, Bont L, Willem L, Jit M, Beutels P, Bilcke J. Cost-effectiveness of monoclonal antibody and maternal immunization against respiratory syncytial virus (RSV) in infants: Evaluation for six European countries. Vaccine 2023; 41:1623-1631. [PMID: 36737318 DOI: 10.1016/j.vaccine.2023.01.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) imposes a substantial burden on pediatric hospital capacity in Europe. Promising prophylactic interventions against RSV including monoclonal antibodies (mAb) and maternal immunizations (MI) are close to licensure. Therefore, we aimed to evaluate the cost-effectiveness of potential mAb and MI interventions against RSV in infants, for six European countries. METHODS We used a static cohort model to compare costs and health effects of four intervention programs to no program and to each other: year-round MI, year-round mAb, seasonal mAb (October to April), and seasonal mAb plus a catch-up program in October. Input parameters were obtained from national registries and literature. Influential input parameters were identified with the expected value of partial perfect information and extensive scenario analyses (including the impact of interventions on wheezing and asthma). RESULTS From the health care payer perspective, and at a price of €50 per dose (mAb and MI), seasonal mAb plus catch-up was cost-saving in Scotland, and cost-effective for willingness-to-pay (WTP) values ≥€20,000 (England, Finland) or €30,000 (Denmark) per quality adjusted life-year (QALY) gained for all scenarios considered, except when using ICD-10 based hospitalization data. For the Netherlands, seasonal mAb was preferred (WTP value: €30,000-€90,000) for most scenarios. For Veneto region (Italy), either seasonal mAb with or without catch-up or MI was preferred, depending on the scenario and WTP value. From a full societal perspective (including leisure time lost), the seasonal mAb plus catch-up program was cost-saving for all countries except the Netherlands. CONCLUSION The choice between a MI or mAb program depends on the level and duration of protection, price, availability, and feasibility of such programs, which should be based on the latest available evidence. Future research should focus on measuring accurately age-specific RSV-attributable hospitalizations in very young children.
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Affiliation(s)
- Abraham M Getaneh
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium
| | - Xiao Li
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium.
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium
| | - Caroline K Johannesen
- Departmenet of Virology and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Research, Nordsjællands Hospital, Hilleroed, Denmark
| | - Elisa Barbieri
- Divisione di Malattie Infettive Pediatriche, Dipartimento di Salute per la Donna e il Bambino, Universita' degli Studi di Padova, Padua, Italy
| | | | - Xin Wang
- School of Public Health, Nanjing Medical University, Jiangsu, China; Centre for Global Health, The University of Edinburgh, Edinburgh, UK
| | | | - Eugenio Baraldi
- Unita' Intensiva Neonatale, Dipartimento di Salute per la Donna e il Bambino, Universita' degli Studi di Padova, Padua, Italy
| | - Emily Phijffer
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Caterina Rizzo
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Italy
| | - Maarten van Wijhe
- Departmenet of Virology and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark; Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Louis Bont
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; The Respiratory Syncytial Virus Network (ReSViNET) Foundation, Zeist, The Netherlands
| | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium
| | - Joke Bilcke
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium
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11
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Nicod E, Lloyd AJ, Morel T, Meregaglia M, Upadhyaya S, Whittal A, Facey K, Drummond M. Improving Interpretation of Evidence Relating to Quality of Life in Health Technology Assessments of Rare Disease Treatments. THE PATIENT 2023; 16:7-17. [PMID: 36217098 DOI: 10.1007/s40271-022-00598-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/05/2022]
Abstract
Rare diseases are often severe, debilitating, life-limiting conditions, many of which occur in childhood. These complex conditions have a wide range of clinical manifestations that have a substantial impact on the lives of patients, carers and families and often produce heterogeneous clinical outcomes. Therefore, the evaluation of quality-of-life (QoL) impacts is important. In health technology assessment (HTA), patient-reported outcome measures (PROMs) and/or health state utility values (HSUVs) are used to determine QoL impacts of new treatments, but their use in rare diseases is challenging due to small and heterogeneous populations and limited disease knowledge. This paper describes challenges associated with the use of patient-reported outcomes (PROs)/HSUVs to evaluate QoL in HTA of rare disease treatments (RDTs) and identifies five recommendations to ensure appropriate interpretation of QoL impacts. These were derived from mixed methods research (literature reviews, appraisal document analyses, appraisal committee observations and interviews) examining the use of PROs/HSUVs in HTA of RDTs. They highlight that HTAs of RDTs must (1) understand the QoL impacts of the disease and of treatments; (2) critically assess PRO data, recognising the nuances in development and administration of PROMs/HSUVs, considering what is feasible and what matters most to the patient population; (3) recognise that lack of significant effect on a PRO does not imply no QoL benefit; (4) use different forms of evidence to understand QoL impacts, such as patient input; and (5) provide methodological guidance to capture QoL impacts on patients/carers.
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Affiliation(s)
- Elena Nicod
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy. .,Dolon Ltd, London, UK.
| | - Andrew J Lloyd
- Acaster Lloyd Consulting Ltd, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Morel
- UCB Pharma, Brussels, Belgium.,KU Leuven, Leuven, Belgium
| | - Michela Meregaglia
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | | | - Amanda Whittal
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Karen Facey
- Usher Institute, University of Edinburgh, Edinburgh, UK
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12
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Goodwin M, Emsley R, Kelly MP, Sutton M, Tickle M, Walsh T, Whittaker W, Pretty IA. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/shmx1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Water fluoridation was introduced in the UK against a background of high dental decay within the population. Levels of decay have dramatically reduced over the last 40 years following widespread use of fluoride toothpaste.
Objective
The aim of the CATFISH (Cumbrian Assessment of Teeth a Fluoride Intervention Study for Health) study was to address the question of whether or not the addition of fluoride to community drinking water, in a contemporary population, lead to a reduction in the number of children with caries and, if so, is this reduction cost-effective?
Design
A longitudinal prospective cohort design was used in two distinct recruited populations: (1) a birth cohort to assess systemic and topical effects of water fluoridation and (2) an older school cohort to assess the topical effects of drinking fluoridated water.
Setting
The study was conducted in Cumbria, UK. Broadly, the intervention group (i.e. individuals receiving fluoridated drinking water) were from the west of Cumbria and the control group were from the east of Cumbria.
Participants
Children who were lifetime residents of Cumbria were recruited. For the birth cohort, children were recruited at birth (2014–15), and followed until age 5 years. For the older school cohort, children were recruited at age 5 years (2013–14) and followed until the age of 11 years.
Intervention
The provision of a ‘reintroduced fluoridated water scheme’.
Main outcome measures
The primary outcome measure was the presence or absence of decay into dentine in the primary teeth (birth cohort) and permanent teeth (older school cohort). The cost per quality-adjusted life-year was also assessed.
Results
In the birth cohort (n = 1444), 17.4% of children in the intervention group had decay into dentine, compared with 21.4% of children in the control group. The evidence, after adjusting for deprivation, age and sex, with an adjusted odds ratio of 0.74 (95% confidence interval 0.56 to 0.98), suggested that water fluoridation was likely to have a modest beneficial effect. There was insufficient evidence of difference in the presence of decay in children in the older school cohort (n = 1192), with 19.1% of children in the intervention group having decay into dentine, compared with 21.9% of children in the control group (adjusted odds ratio 0.80, 95% confidence interval 0.58 to 1.09). The intervention was found to be likely to be cost-effective for both the birth cohort and the older school cohort at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. There was no significant difference in the performance of water fluoridation on caries experience across deprivation quintiles.
Conclusions
The prevalence of caries and the impact of water fluoridation was much smaller than previous studies have reported. The intervention was effective in the birth cohort group; however, the importance of the modest absolute reduction in caries (into dentine) needs to be considered against the use of other dental caries preventative measures. Longer-term follow-up will be required to fully understand the balance of benefits and potential risks (e.g. fluorosis) of water fluoridation in contemporary low-caries populations.
Limitations
The low response rates to the questionnaires reduced their value for generalisations. The observed numbers of children with decay and the postulated differences between the groups were far smaller than anticipated and, consequently, the power of the study was affected (i.e. increasing the uncertainty indicated in the confidence intervals).
Study registration
This study is registered as Integrated Research Application System 131824 and 149278.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - William Whittaker
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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13
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Mpundu-Kaambwa C, Bulamu N, Lines L, Chen G, Dalziel K, Devlin N, Ratcliffe J. A Systematic Review of International Guidance for Self-Report and Proxy Completion of Child-Specific Utility Instruments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1791-1804. [PMID: 35667950 DOI: 10.1016/j.jval.2022.04.1723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/04/2022] [Accepted: 04/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to identify and summarize published guidance and recommendations for child self- and proxy assessment of existing child-specific instruments of health-related quality of life (HRQoL) that are accompanied by utilities. METHODS A total of 9 databases plus websites of (1) health technology assessment and health economics outcomes research organizations and (2) instrument developers were systematically searched. Studies were included if they reported guidance for child self- and proxy assessment for child populations (0-18 years old). Three reviewers independently screened titles, abstracts, and full-text reviews against the inclusion criteria. Key features of the guidance identified were summarized. RESULTS A total of 19 studies met the inclusion criteria. In general, journal articles provided little guidance on child self- and proxy assessment, with the majority focused on instrument development and psychometric performance more broadly. Instrument developers' websites provided more guidance for child self- and proxy reports with specific guidance found for the EQ-5D-Y and the Pediatric Quality of Life Inventory. This guidance included the minimum age for self-report and mode of administration; recommended proxy types, age range of child for whom proxy report can be completed, and target population; and recall period. Websites of leading organizations provided general guidance on HRQoL evaluation in children but lacked specific guidance about self- and proxy completion. CONCLUSIONS EQ-5D-Y and Pediatric Quality of Life Inventory developers' websites provided the most comprehensive guidance for self-report and proxy report of their respective instruments. More evidence is required for developing best practice guidance on why, when, and how to use self- and proxy reports in assessing HRQoL in child populations.
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Affiliation(s)
| | - Norma Bulamu
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Lauren Lines
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nancy Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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14
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Devlin N, Pan T, Kreimeier S, Verstraete J, Stolk E, Rand K, Herdman M. Valuing EQ-5D-Y: the current state of play. Health Qual Life Outcomes 2022; 20:105. [PMID: 35794607 PMCID: PMC9260978 DOI: 10.1186/s12955-022-01998-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND For nearly a decade, value sets for the EQ-5D-Y were not available, reflecting challenges in valuing child HRQoL. A methodological research programme led to publication of a valuation protocol in 2020, which was rapidly taken up by local study teams. By the end of 2022, between 11 and 17 EQ-5D-Y value sets will be available, more than for any other child HRQoL measure. It is timely to review the experience of those using the protocol to identify early learnings and remaining issues where more research is needed. METHODS In June 2021, the EuroQol Group organised a three-day workshop, bringing together all those involved in EQ-5D-Y value set studies and related methodological research concerning EQ-5D-Y and valuation. Workshop discussions were captured by note taking and recording all sessions and online chat. A narrative summary of all sessions was produced and synthesised to identify points of agreement and aspects of methods where uncertainty remains. RESULTS There was broad agreement that DCE is working well as the principal valuation method. However, the most appropriate means of anchoring the latent scale values produced by DCE remains unclear. Some studies have deviated from the protocol by extending the number of states included in TTO tasks, to better support modelling of DCE and TTO. There is ongoing discussion about the relative merits of alternative variants of TTO and other methods for anchoring. Very few studies have consulted with local end-users to gauge the acceptability of methods used to value EQ-5D-Y. CONCLUSIONS Priority areas for research include testing alternative methods for anchoring DCE data; exploring the preferences of adolescents; and scale differences in values for EQ-5D-Y and adult EQ-5D states, and implications of such differences for the use of EQ-5D-Y values in HTA. Given the normative elements of the protocol, engaging with HTA bodies and other local users should be the first step for all future value set studies. Value sets undertaken to date are for the three-level EQ-5D-Y. However, the issues discussed in this paper are equally relevant to valuation of the five-level version of EQ-5D-Y; indeed, similar challenges are encountered valuing any measure of child HRQoL.
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Affiliation(s)
- N Devlin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Parkville, VIC, 3010, Australia.
- Office of Health Economics, London, UK.
| | - T Pan
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Parkville, VIC, 3010, Australia
| | - S Kreimeier
- Department of Health Economics and Health Care Management, Faculty of Health Science, Bielefeld University, Bielefeld, Germany
| | - J Verstraete
- Division of Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - E Stolk
- EuroQol Research Foundation, Rotterdam, Netherlands
| | - K Rand
- Health Services Research Centre, Akershus University Hospital, Nordbyhagen, Norway
| | - M Herdman
- Office of Health Economics, London, UK
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15
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Bailey C, Howell M, Raghunandan R, Salisbury A, Chen G, Coast J, Craig JC, Devlin NJ, Huynh E, Lancsar E, Mulhern BJ, Norman R, Petrou S, Ratcliffe J, Street DJ, Howard K, Viney R. Preference Elicitation Techniques Used in Valuing Children's Health-Related Quality-of-Life: A Systematic Review. PHARMACOECONOMICS 2022; 40:663-698. [PMID: 35619044 PMCID: PMC9270310 DOI: 10.1007/s40273-022-01149-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Valuing children's health states for use in economic evaluations is globally relevant and is of particular relevance in jurisdictions where a cost-utility analysis is the preferred form of analysis for decision making. Despite this, the challenges with valuing child health mean that there are many remaining questions for debate about the approach to elicitation of values. The aim of this paper was to identify and describe the methods used to value children's health states and the specific issues that arise in the use of these methods. METHODS We conducted a systematic search of electronic databases to identify studies published in English since 1990 that used preference elicitation methods to value child and adolescent (under 18 years of age) health states. Eligibility criteria comprised valuation studies concerning both child-specific patient-reported outcome measures and child health states defined in other ways, and methodological studies of valuation approaches that may or may not have yielded a value set algorithm. RESULTS A total of 77 eligible studies were identified from which data on country setting, aims, condition (general population or clinically specific), sample size, age of respondents, the perspective that participants were asked to adopt, source of values (respondents who completed the preference elicitation tasks) and methods questions asked were extracted. Extracted data were classified and evaluated using narrative synthesis methods. The studies were classified into three groups: (1) studies comparing elicitation methods (n = 30); (2) studies comparing perspectives (n = 23); and (3) studies where no comparisons were presented (n = 26); selected studies could fall into more than one group. Overall, the studies varied considerably both in methods used and in reporting. The preference elicitation tasks included time trade-off, standard gamble, visual analogue scaling, rating/ranking, discrete choice experiments, best-worst scaling and willingness to pay elicited through a contingent valuation. Perspectives included adults' considering the health states from their own perspective, adults taking the perspective of a child (own, other, hypothetical) and a child/adolescent taking their own or the perspective of another child. There was some evidence that children gave lower values for comparable health states than did adults that adopted their own perspective or adult/parents that adopted the perspective of children. CONCLUSIONS Differences in reporting limited the conclusions that can be formed about which methods are most suitable for eliciting preferences for children's health and the influence of differing perspectives and values. Difficulties encountered in drawing conclusions from the data (such as lack of consensus and poor reporting making it difficult for users to choose and interpret available values) suggest that reporting guidelines are required to improve the consistency and quality of reporting of studies that value children's health using preference-based techniques.
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Affiliation(s)
- Cate Bailey
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne, VIC, Australia.
| | - Martin Howell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rakhee Raghunandan
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amber Salisbury
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nancy J Devlin
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
| | - Elisabeth Huynh
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Lancsar
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Brendan J Mulhern
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deborah J Street
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rosalie Viney
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
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16
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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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17
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Santos M, Monteiro AL, Biz AN, Guerra A, Cramer H, Canuto V, Cruz L, Pinto M, Viegas M, Fernandes R, Zimmermann I. Guidelines for Utility Measurement for Economic Analysis: The Brazilian Policy. Value Health Reg Issues 2022; 31:67-73. [PMID: 35533599 DOI: 10.1016/j.vhri.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/07/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Health-related quality of life is expressed in utilities, also referred to as utility estimates or parameters. Considerations about the source and type of utility values are especially important in a modeling context, where the lack of transparency, including the lack of a hierarchy for utility data sources, is a major issue to any estimation and can potentially compromise model reliability. OBJECTIVES This document aims to present the first version of the Brazilian guidelines for utility measurement to support economic analysis. METHODS A virtual workshop and a modified Delphi panel with 10 health technology specialists followed a rapid evaluation of 110 technical documents and indexed publications. The recommendations are based on the proposition that has received the most votes, although contentious issues are addressed in the suggestion or discussion. The rationale for the final decision is included in the text. RESULTS The consensus includes 50 recommendations with the following topics: Transparency and Reliability, Model Design, Conditions Under Which Generic Questionnaires Are Not Sensible or Valid, Utility Evidence Hierarchy, Utility Data Searching, Modeling Utility Values, Extrapolating Quality Adjusted Life-Years for Models With Lifetime Horizons, Caregiver Utility, Utility Data Synthesis, Quality/Certainty of the Evidence, and Utility Estimates in End-of-Life Conditions. CONCLUSIONS The goal of this project is to create unified national standards for using utility metrics in economic analysis in Brazil. This set of recommendations is not obligatory, but it is meant to serve as a guide and lead to the development of better and more transparent economic models in the country.
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Affiliation(s)
- Marisa Santos
- National Institute of Cardiology, Rio de Janeiro, Brazil.
| | - Andrea Liborio Monteiro
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Aline Navega Biz
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, England, UK
| | - Augusto Guerra
- Department of Social Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Helena Cramer
- National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Vania Canuto
- Department of Management and Incorporation of Health Technologies, Ministry of Health, Brazil
| | - Luciane Cruz
- Research Project Office, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Marcia Pinto
- National Institute of Women's, Children's and Adolescents' Health Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Ivan Zimmermann
- Faculty of Medicine, University of Brasilia, Brasilia, Brazil
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18
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Åström M, Rolfson O, Burström K. Exploring EQ-5D-Y-3L Experience-Based VAS Values Derived Among Adolescents. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:383-393. [PMID: 35083734 PMCID: PMC9021108 DOI: 10.1007/s40258-021-00713-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The EQ-5D-Y-3L is a generic health-related quality of life (HRQoL) instrument, developed from the adult version to be suitable for children and adolescents aged 8-15 years. To derive values for the EQ-5D-Y-3L different valuation methods and perspectives have been applied. The aim of this study was to explore EQ-5D-Y-3L experience-based visual analogue scale (VAS) values derived among adolescents. METHODS Data were derived from a cross-sectional population survey administered via schools in 2014 to adolescents aged 13-18 years, in Sweden. Regression analyses were performed on individual data with the VAS value as dependent variable. Ordinary least-squares (OLS) and generalised linear models (GLM) were estimated with two dummy variables for each of the EQ-5D-Y-3L dimensions. Interaction variables were tested. One way of anchoring VAS at dead and full health by using the predicted values for worst and best health states defined by the EQ-5D-Y-3L descriptive system was explored. RESULTS Of the 243 possible health states in EQ-5D-Y-3L, 92 were reported by the 6,468 respondents. The largest decrements in VAS values were observed for the dimension 'feeling worried, sad or unhappy' followed by 'doing usual activities'. All models performed similarly in terms of monotonicity and goodness of fit but in terms of simplicity and understandability, the OLS main effect model was superior. CONCLUSIONS We have explored experience-based VAS values for the EQ-5D-Y-3L derived among adolescents. The findings suggest that it is possible for adolescents to value their own health state using the VAS, which makes it possible to capture aspects that are important for young people.
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Affiliation(s)
- Mimmi Åström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden.
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Dawoud D, Lamb A, Moore A, Bregman C, Rupniewska E, Paling T, Wolfram V, Lovett RES, Dent R. Capturing what matters: updating NICE methods guidance on measuring and valuing health. Qual Life Res 2022; 31:2167-2173. [PMID: 35247152 PMCID: PMC9188493 DOI: 10.1007/s11136-022-03101-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
In July 2019, the National Institute for Health and Care Excellence (NICE) initiated a major review of its health technology evaluation methods to update its methods guide. This update has recently concluded with the publication of its health technology evaluation manual in January 2022. This paper reports the methods and findings of the review in relation to the recommended approach to use for the measurement and valuation of health-related quality of life (HRQoL) in submissions to NICE. Issues related to (i) the methods to use when NICE’s preferred measure (EQ-5D) is not appropriate or not available; (ii) adjusting health state utility values over time to account for age; (iii) measuring and valuing HRQoL in children and young people; and (iv) including carers’ QoL in economic evaluations were included in this review. This commentary summarises the methods used to undertake the review, its findings, and the changes to NICE methods that were proposed based on these findings. It also outlines topics where further research is needed before definitive methods guidance can be issued. The broad proposals described here were subject to a public consultation in 2020 and a further consultation on the updated methods guidance was completed in October 2021 before the publication of the manual in January 2022.
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Affiliation(s)
- Dalia Dawoud
- National Institute for Health and Care Excellence (NICE), Manchester, UK.
| | - Alan Lamb
- National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Alan Moore
- National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Caroline Bregman
- National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Ewa Rupniewska
- National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Thomas Paling
- National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Verena Wolfram
- National Institute for Health and Care Excellence (NICE), Manchester, UK
| | | | - Ross Dent
- National Institute for Health and Care Excellence (NICE), Manchester, UK
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Gallop K, Acaster S, de Vries J, Browne R, Ryan R, Baker S, Du Toit G. Exploring Health-Related Quality of Life Burden in Peanut Allergy and the Potential Benefit of Oral Immunotherapy: Estimation of Health State Utility Values for Children and Adolescents and Their Caregivers. Patient Prefer Adherence 2022; 16:1269-1278. [PMID: 35619589 PMCID: PMC9129262 DOI: 10.2147/ppa.s357864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to estimate utility values for health states relating to oral immunotherapy (OIT) for peanut allergy (PA), for children with PA and their caregivers. PATIENTS AND METHODS Two methods were used: an online survey and structured interviews. Both methods assessed current utility/untreated PA (health-related quality of life, HRQoL) and HRQoL in different health states: "up-dosing phase of treatment", "maintenance phase" and "able to tolerate 6-8 peanuts if accidentally ingested". The survey was conducted in individuals with and without experience of OIT; data collected included the EQ-5D-Y (child states) and EQ-5D-5L (caregiver states). RESULTS In total, 100 caregivers and 38 adolescents completed the treatment-naïve survey, a separate sample of 50 caregivers participated in structured interviews. Seven caregivers and two adolescents with experience of OIT for PA completed the survey. Data from the three samples were pooled, the mean utility values were untreated PA: 0.796 (child), 0.855 (caregiver); up-dosing: 0.711 (child), 0.806 (caregiver); maintenance: 0.821 (child), 0.849 (caregiver), tolerate 6-8 peanuts: 0.859 (child), 0.884 (caregiver). The results show a gain in utility of 0.063 for children and 0.029 for caregivers between the untreated and tolerate 6-8 peanuts health states. CONCLUSION This study is the first to assess utilities relating to OIT for PA. The results show the potential benefit of OIT for individuals with PA and their caregivers and provide values for use in cost-effectiveness evaluation.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, London, UK
- Correspondence: Katy Gallop, Acaster Lloyd Consulting, 84 Theobalds Road, London, WC1X 8NL, UK, Tel +44 203 9781686, Email
| | | | | | | | - Robert Ryan
- Aimmune Therapeutics, London, UK
- Robert Ryan, Aimmune Therapeutics, 10 Eastbourne Terrace, London, W2 6LG, UK, Email
| | | | - George Du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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21
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Marson AG, Burnside G, Appleton R, Smith D, Leach JP, Sills G, Tudur-Smith C, Plumpton CO, Hughes DA, Williamson PR, Baker G, Balabanova S, Taylor C, Brown R, Hindley D, Howell S, Maguire M, Mohanraj R, Smith PE. Lamotrigine versus levetiracetam or zonisamide for focal epilepsy and valproate versus levetiracetam for generalised and unclassified epilepsy: two SANAD II non-inferiority RCTs. Health Technol Assess 2021; 25:1-134. [PMID: 34931602 DOI: 10.3310/hta25750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Levetiracetam (Keppra®, UCB Pharma Ltd, Slough, UK) and zonisamide (Zonegran®, Eisai Co. Ltd, Tokyo, Japan) are licensed as monotherapy for focal epilepsy, and levetiracetam is increasingly used as a first-line treatment for generalised epilepsy, particularly for women of childbearing age. However, there is uncertainty as to whether or not they should be recommended as first-line treatments owing to a lack of evidence of clinical effectiveness and cost-effectiveness. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of lamotrigine (Lamictal®, GlaxoSmithKline plc, Brentford, UK) (standard treatment) with levetiracetam and zonisamide (new treatments) for focal epilepsy, and to compare valproate (Epilim®, Sanofi SA, Paris, France) (standard treatment) with levetiracetam (new treatment) for generalised and unclassified epilepsy. DESIGN Two pragmatic randomised unblinded non-inferiority trials run in parallel. SETTING Outpatient services in NHS hospitals throughout the UK. PARTICIPANTS Those aged ≥ 5 years with two or more spontaneous seizures that require anti-seizure medication. INTERVENTIONS Participants with focal epilepsy were randomised to receive lamotrigine, levetiracetam or zonisamide. Participants with generalised or unclassifiable epilepsy were randomised to receive valproate or levetiracetam. The randomisation method was minimisation using a web-based program. MAIN OUTCOME MEASURES The primary outcome was time to 12-month remission from seizures. For this outcome, and all other time-to-event outcomes, we report hazard ratios for the standard treatment compared with the new treatment. For the focal epilepsy trial, the non-inferiority limit (lamotrigine vs. new treatments) was 1.329. For the generalised and unclassified epilepsy trial, the non-inferiority limit (valproate vs. new treatments) was 1.314. Secondary outcomes included time to treatment failure, time to first seizure, time to 24-month remission, adverse reactions, quality of life and cost-effectiveness. RESULTS Focal epilepsy. A total of 990 participants were recruited, of whom 330 were randomised to receive lamotrigine, 332 were randomised to receive levetiracetam and 328 were randomised to receive zonisamide. Levetiracetam did not meet the criteria for non-inferiority (hazard ratio 1.329) in the primary intention-to-treat analysis of time to 12-month remission (hazard ratio vs. lamotrigine 1.18, 97.5% confidence interval 0.95 to 1.47), but zonisamide did meet the criteria (hazard ratio vs. lamotrigine 1.03, 97.5% confidence interval 0.83 to 1.28). In the per-protocol analysis, lamotrigine was superior to both levetiracetam (hazard ratio 1.32, 95% confidence interval 1.05 to 1.66) and zonisamide (hazard ratio 1.37, 95% confidence interval 1.08 to 1.73). For time to treatment failure, lamotrigine was superior to levetiracetam (hazard ratio 0.60, 95% confidence interval 0.46 to 0.77) and zonisamide (hazard ratio 0.46, 95% confidence interval 0.36 to 0.60). Adverse reactions were reported by 33% of participants starting lamotrigine, 44% starting levetiracetam and 45% starting zonisamide. In the economic analysis, both levetiracetam and zonisamide were more costly and less effective than lamotrigine and were therefore dominated. Generalised and unclassifiable epilepsy. Of 520 patients recruited, 260 were randomised to receive valproate and 260 were randomised to receive to levetiracetam. A total of 397 patients had generalised epilepsy and 123 had unclassified epilepsy. Levetiracetam did not meet the criteria for non-inferiority in the primary intention-to-treat analysis of time to 12-month remission (hazard ratio 1.19, 95% confidence interval 0.96 to 1.47; non-inferiority margin 1.314). In the per-protocol analysis of time to 12-month remission, valproate was superior to levetiracetam (hazard ratio 1.68, 95% confidence interval 1.30 to 2.15). Valproate was superior to levetiracetam for time to treatment failure (hazard ratio 0.65, 95% confidence interval 0.50 to 0.83). Adverse reactions were reported by 37.4% of participants receiving valproate and 41.5% of those receiving levetiracetam. Levetiracetam was both more costly (incremental cost of £104, 95% central range -£587 to £1234) and less effective (incremental quality-adjusted life-year of -0.035, 95% central range -0.137 to 0.032) than valproate, and was therefore dominated. At a cost-effectiveness threshold of £20,000 per quality-adjusted life-year, levetiracetam was associated with a probability of 0.17 of being cost-effective. LIMITATIONS The SANAD II trial was unblinded, which could have biased results by influencing decisions about dosing, treatment failure and the attribution of adverse reactions. FUTURE WORK SANAD II data could now be included in an individual participant meta-analysis of similar trials, and future similar trials are required to assess the clinical effectiveness and cost-effectiveness of other new treatments, including lacosamide and perampanel. CONCLUSIONS Focal epilepsy - The SANAD II findings do not support the use of levetiracetam or zonisamide as first-line treatments in focal epilepsy. Generalised and unclassifiable epilepsy - The SANAD II findings do not support the use of levetiracetam as a first-line treatment for newly diagnosed generalised epilepsy. For women of childbearing potential, these results inform discussions about the benefit (lower teratogenicity) and harm (worse seizure outcomes and higher treatment failure rate) of levetiracetam compared with valproate. TRIAL REGISTRATION Current Controlled Trials ISRCTN30294119 and EudraCT 2012-001884-64. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 75. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Girvan Burnside
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Richard Appleton
- The Roald Dahl EEG Unit, Alder Hey Children's Health Park, Liverpool, UK
| | - Dave Smith
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Graeme Sills
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Catrin Tudur-Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Catrin O Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Silviya Balabanova
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Claire Taylor
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard Brown
- Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK
| | - Dan Hindley
- Bolton NHS Foundation Trust, Royal Bolton Hospital, Bolton, UK
| | - Stephen Howell
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | | | | | - Philip Em Smith
- The Alan Richens Epilepsy Unit, University Hospital of Wales, Cardiff, UK
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22
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Mitchell PM, Husbands S, Byford S, Kinghorn P, Bailey C, Peters TJ, Coast J. Challenges in developing capability measures for children and young people for use in the economic evaluation of health and care interventions. HEALTH ECONOMICS 2021; 30:1990-2003. [PMID: 34036671 PMCID: PMC7614859 DOI: 10.1002/hec.4363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 05/26/2023]
Abstract
Methods for measuring outcomes suitable for economic evaluations of health and care interventions have primarily focused on adults. The validity of such methods for children and young people is questionable in areas including the outcome domains measured and how they are measured and valued, with most existing measures narrowly focusing on health. Novel methods for assessing benefits beyond health by focusing on a person's capability have also concentrated on adults to date. This paper aims to set out the rationale for capability measures in children and young people. It argues for the need to expand the evaluative space beyond health functioning towards broader capabilities, with children and young people playing an integral role in capability measure development. Drawing from existing literature, specific challenges related to the identification, measurement, and valuation of capabilities in children and young people are also discussed. Finally, the practical implications for conducting economic evaluation when measuring and valuing capabilities at different stages across the life-course are illustrated. We develop an alternative framework based on conceiving capabilities as evolving across the life-course. This framework may also be helpful in thinking about how to model health outcomes across the life-course.
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Affiliation(s)
- Paul Mark Mitchell
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Samantha Husbands
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Byford
- King's Health Economics (KHE), Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip Kinghorn
- Health Economics Unit (HEU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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23
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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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24
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Marson A, Burnside G, Appleton R, Smith D, Leach JP, Sills G, Tudur-Smith C, Plumpton C, Hughes DA, Williamson P, Baker GA, Balabanova S, Taylor C, Brown R, Hindley D, Howell S, Maguire M, Mohanraj R, Smith PE. The SANAD II study of the effectiveness and cost-effectiveness of levetiracetam, zonisamide, or lamotrigine for newly diagnosed focal epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet 2021; 397:1363-1374. [PMID: 33838757 PMCID: PMC8047799 DOI: 10.1016/s0140-6736(21)00247-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Levetiracetam and zonisamide are licensed as monotherapy for patients with focal epilepsy, but there is uncertainty as to whether they should be recommended as first-line treatments because of insufficient evidence of clinical effectiveness and cost-effectiveness. We aimed to assess the long-term clinical effectiveness and cost-effectiveness of levetiracetam and zonisamide compared with lamotrigine in people with newly diagnosed focal epilepsy. METHODS This randomised, open-label, controlled trial compared levetiracetam and zonisamide with lamotrigine as first-line treatment for patients with newly diagnosed focal epilepsy. Adult and paediatric neurology services across the UK recruited participants aged 5 years or older (with no upper age limit) with two or more unprovoked focal seizures. Participants were randomly allocated (1:1:1) using a minimisation programme with a random element utilising factor to receive lamotrigine, levetiracetam, or zonisamide. Participants and investigators were not masked and were aware of treatment allocation. SANAD II was designed to assess non-inferiority of both levetiracetam and zonisamide to lamotrigine for the primary outcome of time to 12-month remission. Anti-seizure medications were taken orally and for participants aged 12 years or older the initial advised maintenance doses were lamotrigine 50 mg (morning) and 100 mg (evening), levetiracetam 500 mg twice per day, and zonisamide 100 mg twice per day. For children aged between 5 and 12 years the initial daily maintenance doses advised were lamotrigine 1·5 mg/kg twice per day, levetiracetam 20 mg/kg twice per day, and zonisamide 2·5 mg/kg twice per day. All participants were included in the intention-to-treat (ITT) analysis. The per-protocol (PP) analysis excluded participants with major protocol deviations and those who were subsequently diagnosed as not having epilepsy. Safety analysis included all participants who received one dose of any study drug. The non-inferiority limit was a hazard ratio (HR) of 1·329, which equates to an absolute difference of 10%. A HR greater than 1 indicated that an event was more likely on lamotrigine. The trial is registered with the ISRCTN registry, 30294119 (EudraCt number: 2012-001884-64). FINDINGS 990 participants were recruited between May 2, 2013, and June 20, 2017, and followed up for a further 2 years. Patients were randomly assigned to receive lamotrigine (n=330), levetiracetam (n=332), or zonisamide (n=328). The ITT analysis included all participants and the PP analysis included 324 participants randomly assigned to lamotrigine, 320 participants randomly assigned to levetiracetam, and 315 participants randomly assigned to zonisamide. Levetiracetam did not meet the criteria for non-inferiority in the ITT analysis of time to 12-month remission versus lamotrigine (HR 1·18; 97·5% CI 0·95-1·47) but zonisamide did meet the criteria for non-inferiority in the ITT analysis versus lamotrigine (1·03; 0·83-1·28). The PP analysis showed that 12-month remission was superior with lamotrigine than both levetiracetam (HR 1·32 [97·5% CI 1·05 to 1·66]) and zonisamide (HR 1·37 [1·08-1·73]). There were 37 deaths during the trial. Adverse reactions were reported by 108 (33%) participants who started lamotrigine, 144 (44%) participants who started levetiracetam, and 146 (45%) participants who started zonisamide. Lamotrigine was superior in the cost-utility analysis, with a higher net health benefit of 1·403 QALYs (97·5% central range 1·319-1·458) compared with 1·222 (1·110-1·283) for levetiracetam and 1·232 (1·112, 1·307) for zonisamide at a cost-effectiveness threshold of £20 000 per QALY. Cost-effectiveness was based on differences between treatment groups in costs and QALYs. INTERPRETATION These findings do not support the use of levetiracetam or zonisamide as first-line treatments for patients with focal epilepsy. Lamotrigine should remain a first-line treatment for patients with focal epilepsy and should be the standard treatment in future trials. FUNDING National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Anthony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.
| | - Girvan Burnside
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Richard Appleton
- The Roald Dahl EEG Unit, Alder Hey Children's Health Park, Liverpool, UK
| | - Dave Smith
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Graeme Sills
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Catrin Tudur-Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK
| | - Paula Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Gus A Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Silviya Balabanova
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Claire Taylor
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard Brown
- Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK
| | - Dan Hindley
- Bolton NHS Foundation Trust, Royal Bolton Hospital, Lancashire, UK
| | - Stephen Howell
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | | | | | - Philip E Smith
- The Alan Richens Epilepsy Unit, University Hospital of Wales, Cardiff, Wales, UK
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25
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Marson A, Burnside G, Appleton R, Smith D, Leach JP, Sills G, Tudur-Smith C, Plumpton C, Hughes DA, Williamson P, Baker GA, Balabanova S, Taylor C, Brown R, Hindley D, Howell S, Maguire M, Mohanraj R, Smith PE. The SANAD II study of the effectiveness and cost-effectiveness of valproate versus levetiracetam for newly diagnosed generalised and unclassifiable epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet 2021; 397:1375-1386. [PMID: 33838758 PMCID: PMC8047813 DOI: 10.1016/s0140-6736(21)00246-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Valproate is a first-line treatment for patients with newly diagnosed idiopathic generalised or difficult to classify epilepsy, but not for women of child-bearing potential because of teratogenicity. Levetiracetam is increasingly prescribed for these patient populations despite scarcity of evidence of clinical effectiveness or cost-effectiveness. We aimed to compare the long-term clinical effectiveness and cost-effectiveness of levetiracetam compared with valproate in participants with newly diagnosed generalised or unclassifiable epilepsy. METHODS We did an open-label, randomised controlled trial to compare levetiracetam with valproate as first-line treatment for patients with generalised or unclassified epilepsy. Adult and paediatric neurology services (69 centres overall) across the UK recruited participants aged 5 years or older (with no upper age limit) with two or more unprovoked generalised or unclassifiable seizures. Participants were randomly allocated (1:1) to receive either levetiracetam or valproate, using a minimisation programme with a random element utilising factors. Participants and investigators were aware of treatment allocation. For participants aged 12 years or older, the initial advised maintenance doses were 500 mg twice per day for levetiracetam and valproate, and for children aged 5-12 years, the initial daily maintenance doses advised were 25 mg/kg for valproate and 40 mg/kg for levetiracetam. All drugs were administered orally. SANAD II was designed to assess the non-inferiority of levetiracetam compared with valproate for the primary outcome time to 12-month remission. The non-inferiority limit was a hazard ratio (HR) of 1·314, which equates to an absolute difference of 10%. A HR greater than 1 indicated that an event was more likely on valproate. All participants were included in the intention-to-treat (ITT) analysis. Per-protocol (PP) analyses excluded participants with major protocol deviations and those who were subsequently diagnosed as not having epilepsy. Safety analyses included all participants who received one dose of any study drug. This trial is registered with the ISRCTN registry, 30294119 (EudraCt number: 2012-001884-64). FINDINGS 520 participants were recruited between April 30, 2013, and Aug 2, 2016, and followed up for a further 2 years. 260 participants were randomly allocated to receive levetiracetam and 260 participants to receive valproate. The ITT analysis included all participants and the PP analysis included 255 participants randomly allocated to valproate and 254 randomly allocated to levetiracetam. Median age of participants was 13·9 years (range 5·0-94·4), 65% were male and 35% were female, 397 participants had generalised epilepsy, and 123 unclassified epilepsy. Levetiracetam did not meet the criteria for non-inferiority in the ITT analysis of time to 12-month remission (HR 1·19 [95% CI 0·96-1·47]); non-inferiority margin 1·314. The PP analysis showed that the 12-month remission was superior with valproate than with levetiracetam. There were two deaths, one in each group, that were unrelated to trial treatments. Adverse reactions were reported by 96 (37%) participants randomly assigned to valproate and 107 (42%) participants randomly assigned to levetiracetam. Levetiracetam was dominated by valproate in the cost-utility analysis, with a negative incremental net health benefit of -0·040 (95% central range -0·175 to 0·037) and a probability of 0·17 of being cost-effectiveness at a threshold of £20 000 per quality-adjusted life-year. Cost-effectiveness was based on differences between treatment groups in costs and quality-adjusted life-years. INTERPRETATION Compared with valproate, levetiracetam was found to be neither clinically effective nor cost-effective. For girls and women of child-bearing potential, these results inform discussions about benefit and harm of avoiding valproate. FUNDING National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Anthony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.
| | - Girvan Burnside
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Richard Appleton
- The Roald Dahl EEG Unit, Alder Hey Children's Health Park, Liverpool, UK
| | - Dave Smith
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Graeme Sills
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Catrin Tudur-Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK
| | - Paula Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Gus A Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Silviya Balabanova
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Claire Taylor
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard Brown
- Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK
| | - Dan Hindley
- Bolton NHS Foundation Trust, Royal Bolton Hospital, Lancashire, UK
| | - Stephen Howell
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | | | | | - Philip E Smith
- The Alan Richens Epilepsy Unit, University Hospital of Wales, Cardiff, Wales, UK
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26
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Wolf RT, Ratcliffe J, Chen G, Jeppesen P. The longitudinal validity of proxy-reported CHU9D. Qual Life Res 2021; 30:1747-1756. [PMID: 33582966 PMCID: PMC8178153 DOI: 10.1007/s11136-021-02774-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
Objectives The Child Health Utility 9D (CHU9D) currently represents the only preference-based health-related quality-of-life instrument designed exclusively from its inception for application with children. The objective of this study was to examine the construct validity and responsiveness of the proxy-reported (parent) CHU9D in a mental health setting using utility weights derived from an adult and adolescent population, respectively. Methods The discriminant validity and convergent validity were examined using the mental health-specific ‘The Strengths and Difficulties Questionnaire’ (SDQ) and the generic KIDSCREEN-27. Responsiveness was assessed by examining the floor-ceiling effects, the magnitude of change over time, and the ability to differentiate between improvement and no improvement. Results The study included 396 children with mental health problems. CHU9D showed good construct validity, with correlation coefficients ranging between 0.329 and 0.571 for SDQ Impact score and KIDSCREEN-27 Psychological Well-being. CHU9D was able to distinguish between groups of children with different levels of mental health problems (p < 0.001). The absolute magnitudes of the group mean differences were larger using adolescent weights. No evidence of a floor/ceiling effect was found at the baseline. A standardized response mean of 0.634–0.654 was found for the children who experienced clinically significant improvements. CHU9D was able to discriminate between children who experienced positive and no health improvements (p < 0.001). Conclusion This study provides the first evidence on responsiveness for CHU9D in a mental health context. The findings demonstrate that CHU9D is an appropriate HRQOL measure for use in mental health trials. Furthermore, the results show that the preference weights generated from an adolescent population resulted in the larger mean differences between groups. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02774-9.
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Affiliation(s)
- Rasmus Trap Wolf
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark. .,Child and Adolescent Mental Health Centre, Mental Health Services-Capital Region of Denmark, Odense, Denmark.
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Pia Jeppesen
- Child and Adolescent Mental Health Centre, Mental Health Services-Capital Region of Denmark, Odense, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pennington BM. Inclusion of Carer Health-Related Quality of Life in National Institute for Health and Care Excellence Appraisals. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1349-1357. [PMID: 33032779 DOI: 10.1016/j.jval.2020.05.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Health interventions for patients can have effects on their carers too. For consistency, decision makers may wish to specify whether carer outcomes should be included. One example is the National Institute for Health and Care Excellence (NICE), whose reference case specifies that economic evaluations should include direct health effects for patients and carers where relevant. We aimed to review the methods used in including carer health-related quality of life (HRQL) in NICE appraisals. METHODS We reviewed all published technology appraisals (TAs) and highly specialized technologies (HSTs) to identify those that included carer HRQL and discussed the methods and data sources. RESULTS Twelve of 414 TAs (3%) and 4 of 8 HSTs (50%) included carer HRQL in cost-utility analyses. Eight were for multiple sclerosis, the remainder were each in a unique disease area. Twelve of the 16 appraisals modeled carer HRQL as a function of the patient's health state, 3 modeled carer HRQL as a function of the patient's treatment, and 1 included family quality-adjusted life year (QALY) loss. They used 5 source studies: 2 compared carer EQ-5D scores with controls, 2 measured carer utility only (1 health utilities index and 1 EQ-5D), and 1 estimated family QALY loss from a child's death. Two used disutility estimates not from the literature. Including carer HRQL increased the incremental QALYs and decreased incremental cost-effectiveness ratios in all cases. CONCLUSIONS The inclusion of carer HRQL in NICE appraisals is relatively uncommon and has been limited by data availability.
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Affiliation(s)
- Becky M Pennington
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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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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