Sullivan Shannon M, Tsiplova Kate, Ungar Wendy J
a University of Ottawa Heart Institute , Ottawa , Canada.
b Program of Child Health Evaluative Sciences , The Hospital for Sick Children Research Institute , Toronto , Canada.
Expert Rev Pharmacoecon Outcomes Res. 2016 Oct;16(5):599-607. doi: 10.1080/14737167.2016.1240618.
Economic evaluations conducted in children have unique features compared to adults. Important developments in pediatric economic evaluation in recent years include new options for valuing health states for cost-utility analysis (CUA) and shifting child health priorities. The Pediatric Economic Database Evaluation (PEDE) project includes a comprehensive database of pediatric health economic evaluations published since 1980. The objective of this scoping review was to identify trends over time in the use of CUA and other analytic techniques, and the therapeutic areas chosen for study. Areas covered: Medical and grey literature were searched, key characteristics were extracted, frequencies were tabulated and cross-tabulations were performed. Differences between early (1980 and 1999) and late (2000 and 2014) periods were assessed using a chi-squared statistic. Of the 2,776 pediatric economic evaluations published between 1980 and 2014, substantially more were cost-effectiveness analyses (CEAs) and CUAs than cost benefit analyses and cost minimization analyses (63.9 and 24.9% versus 7.6 and 3.6%, respectively). This pattern was consistent regardless of the type of intervention, disease or age group studied. A trend toward higher proportions of CUAs and CEAs was evident in the later period (X p < 0.0001). Other significant trends included a higher proportion of studies of preventive interventions (X p < 0.0001), and more studies in children aged 1 to 12 years and fewer in perinates in the later period (X p < 0.0001). Overall the most common disease class studied was infectious diseases (29.2%). Expert commentary: Pediatric economic evaluation continues to grow in volume and methodologic complexity. While CUAs have increased, whether their quality has improved remains unknown. Although most studies are in infectious disease, the volume of publications may not align with emerging child health priorities such as adolescent health, injury, developmental disabilities, mental health, and the use of personalized medicine. Increasing economic evaluations in these areas will enhance pediatric decision-making.
与成人相比，针对儿童开展的经济评估具有独特的特点。近年来儿科经济评估的重要进展包括成本效用分析（CUA）中健康状态估值的新选择以及儿童健康优先事项的转变。儿科经济数据库评估（PEDE）项目包含一个自1980年以来发表的儿科健康经济评估的综合数据库。本范围综述的目的是确定随着时间推移CUA和其他分析技术的使用趋势，以及所选择的研究治疗领域。涵盖领域：检索了医学文献和灰色文献，提取了关键特征，列出了频率并进行了交叉制表。使用卡方统计量评估早期（1980年和1999年）和晚期（2000年和2014年）之间的差异。在1980年至2014年发表的2776项儿科经济评估中，成本效益分析（CEA）和CUA的数量远多于成本效益分析和成本最小化分析（分别为63.9%和24.9%，而成本效益分析和成本最小化分析分别为7.6%和3.6%）。无论所研究的干预类型、疾病或年龄组如何，这种模式都是一致的。在后期，CUA和CEA的比例有上升趋势（X p < 0.0001）。其他显著趋势包括预防性干预研究的比例更高（X p < 0.0001），后期1至12岁儿童的研究更多，围产期的研究更少（X p < 0.0001）。总体而言，研究最多的常见疾病类别是传染病（29.2%）。专家评论：儿科经济评估在数量和方法复杂性方面持续增长。虽然CUA有所增加，但其质量是否提高仍不清楚。尽管大多数研究是关于传染病的，但出版物数量可能与青少年健康、伤害、发育障碍、心理健康和个性化医疗使用等新出现的儿童健康优先事项不一致。增加这些领域的经济评估将加强儿科决策。
