Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, HITS Building, Rm 1020N, 410 West 10th St., Indianapolis, IN 46202, USA.
Acad Pediatr. 2012 May-Jun;12(3):219-28. doi: 10.1016/j.acap.2011.09.003. Epub 2011 Nov 10.
Economic analyses, such as cost-utility analyses (CUAs), are dependent on the quality of the data used. Our objective was to test how health utility values (measurements of patient preference) assessed by recommended methods (classic utilities) would impact the conclusions in published pediatric CUAs.
Classic utilities for pediatric health states were obtained by recommended utility assessment methods, time trade-off, and standard gamble in 4016 parent interviews. To test the impact of these utilities on published studies, we obtained a sample of published pediatric CUAs by searching Medline, EMBASE, EconLit, Health Technology Assessment Database, Cochrane Database on Systematic Reviews, Database of Abstracts of Reviews of Effects, and the Cost Effective Analysis (CEA) Registry at Tufts Medical Center, using search terms for cost-utility analysis. Articles were included when results were presented as cost per quality adjusted life-years (QALYs), the interventions were for children <18 years of age and included at least one of the following health states: attention deficit hyperactivity disorder, asthma, gastroenteritis, hearing loss, mental retardation, otitis media, seizure disorder, or vision loss. Studies that did not include these or equivalent health states were excluded. For each CUA, we determined utilities (values for patient preference), the utility assessment method used, and presence of one-way sensitivity analyses (SAs) on utilities. When one-way SAs were conducted, we determined if using our classic utilities would change the result of the CUA. When an SA was not presented, we determined if using our classic utilities would tend to support or not support the published conclusions.
We evaluated 39 articles. Eighteen articles presented results of one-way SAs on utilities. Seven articles presented SAs over a range that included our classic utilities. In 4 of the 7, using classic utilities would change the conclusion of the study. For the 32 articles where no one-way SA were presented (n = 21), or where the classic utilities fell outside the range tested (n =11), a change to classic utility would tend against the study conclusion in 12 articles (31%).
More than a third of published CUA studies could change if pediatric utilities obtained by recommended, classic methods were used. One-way SAs on utilities are often not presented, making comparison between studies challenging.
经济分析（如成本效用分析）取决于所用数据的质量。我们的目的是检验通过推荐方法（经典效用）评估的健康效用值（患者偏好的衡量）会如何影响已发表儿科成本效用分析的结论。
通过推荐的效用评估方法、时间权衡和标准博弈对 4016 位家长进行访谈，获得儿科健康状况的经典效用。为了检验这些效用对已发表研究的影响，我们通过在 Medline、EMBASE、EconLit、卫生技术评估数据库、Cochrane 系统评价数据库、效果摘要数据库和 Tufts 医疗中心成本效益分析（CEA）注册中心使用成本效用分析的搜索词，搜索了已发表的儿科成本效用分析，纳入了结果以每质量调整生命年（QALY）成本表示的研究，干预对象为 18 岁以下的儿童，并包括以下至少一种健康状况：注意力缺陷多动障碍、哮喘、肠胃炎、听力损失、智力迟钝、中耳炎、癫痫发作障碍或视力丧失。不包括这些或等效健康状况的研究被排除在外。对于每一项 CUA，我们确定了效用（患者偏好的价值）、使用的效用评估方法以及是否存在对效用的单向敏感性分析（SA）。进行单向 SA 时，我们确定使用我们的经典效用是否会改变 CUA 的结果。当未呈现 SA 时，我们确定使用我们的经典效用是否倾向于支持或不支持已发表的结论。
我们评估了 39 篇文章。18 篇文章介绍了对效用的单向 SA 结果。7 篇文章介绍了涵盖我们经典效用的 SA 范围。在这 7 篇文章中的 4 篇中，使用经典效用会改变研究结论。在没有呈现单向 SA 的 32 篇文章（n=21）或经典效用不在测试范围内的 11 篇文章（n=11）中，在 12 篇文章（31%）中，对经典效用的更改倾向于反对研究结论。
如果使用推荐的经典方法获得的儿科效用，则超过三分之一的已发表 CUA 研究可能会改变。对效用的单向 SA 通常未呈现，这使得研究之间的比较具有挑战性。
