Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, Edgbaston, UK.
Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, Edgbaston, UK.
Value Health. 2014 Jun;17(4):454-61. doi: 10.1016/j.jval.2014.02.007. Epub 2014 Apr 29.
To report findings from a systematic review, this article sought to address two related questions. First, how has the practice of UK pediatric cost-utility analyses evolved over time, in particular how are health-related outcomes assessed and valued? Second, how do the methods compare to the limited guidance available, in particular, the National Institute for Health and Care Excellence (NICE) reference case(s)?
Electronic searches of MEDLINE, Embase, and Cochrane databases were conducted for the period May 2004 to April 2012 and the Paediatric Economic Database Evaluation database for the period May 2004 to December 2010. Identified studies were screened by three independent reviewers.
Forty-three studies were identified, 11 of which elicit utility values through primary research. A discrepancy was identified between the methods used for outcome measurement and valuation and the methods advocated within the NICE reference case. Despite NICE recommending the use of preference-based instruments designed specifically for children, most studies that were identified had used adult measures. In fact, the measurement of quality-adjusted life-years is the aspect of economic evaluation with the greatest amount of variability and the area that most digressed from the NICE reference case.
Recommendations stemming from the review are that all studies should specify the age range of childhood and include separate statements of perspective for costs and effects as well as the reallocation of research funding away from systematic review studies toward good quality primary research measuring utilities in children.
本系统评价旨在报告研究结果，主要针对两个相关问题展开探讨。首先，英国儿科成本效益分析的实践操作是如何随时间演变的，特别是健康相关结局的评估和赋值方法有哪些变化？其次，与有限的可用指导方法（特别是国家卫生与临床优化研究所（NICE）参考病例）相比，这些方法有哪些不同？
对 2004 年 5 月至 2012 年 4 月期间的 MEDLINE、Embase 和 Cochrane 数据库以及 2004 年 5 月至 2010 年 12 月期间的儿科经济数据库评价数据库进行了电子检索。由三位独立评审员对确定的研究进行筛选。
共确定了 43 项研究，其中 11 项通过原始研究获得了效用值。在结局测量和赋值方法以及 NICE 参考病例中倡导的方法之间，发现了不一致之处。尽管 NICE 建议使用专为儿童设计的偏好量表，但大多数确定的研究都使用了成人量表。事实上，衡量质量调整生命年是经济评价中最具可变性的方面，也是最偏离 NICE 参考病例的方面。
本研究的推荐意见是，所有研究都应具体说明儿童的年龄范围，并分别陈述成本和效果的观点，以及将研究资金从系统评价研究重新分配到专门测量儿童效用的高质量原始研究上。
