Department of Economics, University of Warwick, Coventry, UK.
Warwick Medical School, University of Warwick, Coventry, UK.
Med Decis Making. 2018 Apr;38(3):277-305. doi: 10.1177/0272989X17732990. Epub 2017 Oct 7.
A common feature of most reviews or catalogues of health utilities has been their focus on adult health states or derivation of values from adult populations. More generally, utility measurement in or on behalf of children has been constrained by several methodological concerns. The objective of this study was to conduct the first comprehensive systematic review and meta-analysis of primary utility data for childhood conditions and descriptors, and to determine the effects of methodological factors on childhood utilities.
The review followed PRISMA guidelines. PubMed, Embase, Web of Science, PsycINFO, EconLit, CINAHL and Cochrane Library were searched for primary studies reporting health utilities for childhood conditions or descriptors using direct or indirect valuation methods. The Paediatric Economic Database Evaluation (PEDE) Porject was also searched for cost-utility analyses with primary utility values. Mean or median utilities for each of the main samples were catalogued, and weighted averages of utilities for each health condition were estimated, by valuation method. Mixed-effects meta-regression using hierarchical linear modeling was conducted for the most common valuation methods to estimate the utility decrement for each health condition category relative to general childhood population health, as well as the independent effects of methodological factors.
The literature searches resulted in 272 eligible studies. These yielded 3,414 utilities when all sub-groups were considered, covering all ICD-10 chapters relevant to childhood health, 19 valuation methods, 12 respondent types, 8 modes of administration, and data from 36 countries. A total of 1,191 utility values were obtained when only main study samples were considered, and these were catalogued by health condition or descriptor, and methodological characteristics. 1,073 mean utilities for main samples were used for fixed-effects meta-analysis by health condition and valuation method. Mixed-effects meta-regressions estimated that 53 of 76 ICD-10 delineated health conditions, valued using the HUI3, were associated with statistically significant utility decrements relative to general population health, whereas 38 of 57 valued using a visual analog scale (VAS) were associated with statistically significant VAS decrements. For both methods, parental proxy assessment was associated with overestimation of values, whereas adolescents reported lower values than children under 12 y. VAS responses were more heavily influenced by mode of administration than the HUI3.
Utilities and their associated distributions, as well as the independent contributions of methodological factors, revealed by this systematic review and meta-analysis can inform future economic evaluations within the childhood context.
大多数健康效用的综述或目录的一个共同特点是，它们侧重于成人健康状况或从成人人群中得出的价值。更一般地说，儿童的效用测量或代表儿童的效用测量受到了几个方法学问题的限制。本研究的目的是对儿童疾病状况和描述符的主要效用数据进行首次全面的系统综述和荟萃分析，并确定方法学因素对儿童效用的影响。
本研究遵循 PRISMA 指南。通过 PubMed、Embase、Web of Science、PsycINFO、EconLit、CINAHL 和 Cochrane Library 搜索了使用直接或间接估值方法报告儿童疾病状况或描述符健康效用的原始研究。还对儿科经济数据库评估 (PEDE) 项目中具有主要效用值的成本效用分析进行了搜索。按估值方法对每个主要样本的平均或中位数效用进行编目，并估计每个健康状况的效用平均值。使用分层线性建模进行了最常见的估值方法的混合效应荟萃回归，以估计相对于一般儿童人群健康，每个健康状况类别的效用下降情况，以及方法学因素的独立影响。
文献检索共产生 272 项符合条件的研究。当考虑所有亚组时，这些研究共产生了 3414 个效用值，涵盖了与儿童健康相关的所有 ICD-10 章节、19 种估值方法、12 种应答者类型、8 种管理模式以及来自 36 个国家的数据。当仅考虑主要研究样本时，共获得了 1191 个效用值，并按健康状况或描述符以及方法学特征进行了编目。对 1073 个主要样本的平均效用值进行了健康状况和估值方法的固定效应荟萃分析。混合效应荟萃回归估计，在使用 HUI3 进行估值的 76 个 ICD-10 界定的健康状况中，有 53 种与一般人群健康相比具有统计学显著的效用下降，而在使用视觉模拟量表 (VAS) 进行估值的 57 种中，有 38 种与统计学显著的 VAS 下降相关。对于这两种方法，父母代理评估与价值高估有关，而青少年报告的价值低于 12 岁以下的儿童。VAS 反应比 HUI3 更受管理模式的影响。
本系统综述和荟萃分析揭示的效用及其相关分布以及方法学因素的独立贡献，可以为儿童背景下的未来经济评估提供信息。
