VALUE IN HEALTH 17 (2014) 454–461
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/jval
SYSTEMATIC REVIEWS
Is the UK NICE “Reference Case” Influencing the Practice of
Pediatric Quality-Adjusted Life-Year Measurement within
Economic Evaluations?
Nick Adlard, MA, MSc, MBA, Philip Kinghorn, MA, PhD*, Emma Frew, MSc, PhD
Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, Edgbaston, UK
AB STR A CT
Objectives: 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)? Methods: 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. Results: 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. Conclusions:
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.
Keywords: economic evaluation, health-related quality of life,
literature review, pediatric, utility.
Introduction
the difference in costs and QALYs is expressed as an incremental
cost-effectiveness ratio.
Although the reference case is designed to ensure quality and
consistency, there are certain population subgroups in which a
straightforward application of this “reference case” is problematic, with the evaluation of health interventions for children
being one example. There are many well-documented reasons
[2,3] why child health should be conceptualized differently to
adult health, such as the rapid rate of development in childhood;
dependency on parents or other caregivers; differences between
children and adults in terms of disease epidemiology and treatment focus [4,5]; and differences in access to, and uptake of,
health care resources. It may also be inappropriate to apply
preference values that have been elicited for descriptions of
health states experienced by adults with in the context of health
interventions targeted at children.
Indeed, NICE acknowledge that some adjustments will need to
be made to the standard reference case when assessing the cost-
In the United Kingdom, the National Institute for Health and
Care Excellence (NICE) operates as a decision-making body by
making treatment recommendations for the UK National Health
Service on the basis of economic and clinical evidence. NICE
advocates a standardized approach to economic evaluation to
ensure comparability of results and consistency of decision
making [1]. To facilitate this process, NICE has issued a “reference case” for all technology assessment economic evaluations
to adhere to. The reference case includes recommendations for
the adoption of a National Health Service/Personal Social Services perspective for costs; the use of the quality-adjusted lifeyear (QALY), measured using the EuroQol five-dimensional (EQ5D) questionnaire; the application of a 3.5% discount rate to both
costs and outcomes; and, where appropriate, the use of probabilistic sensitivity analysis and a lifetime time horizon [1].
Results are expressed in terms of “cost per QALY” gained, and
Copyright & 2014, International Society for Pharmacoeconomics and
Outcomes Research (ISPOR). Published by Elsevier Inc.
*Address correspondence to: Philip Kinghorn, Health Economics Unit, School of Health & Population Sciences, Public Health Building,
University of Birmingham, Edgbaston B15 2TT, UK.
E-mail: [email protected].
1098-3015$36.00 – see front matter Copyright & 2014, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Published by Elsevier Inc.
http://dx.doi.org/10.1016/j.jval.2014.02.007
VALUE IN HEALTH 17 (2014) 454–461
effectiveness of health care interventions for children. The NICE
“reference case” has changed over time in relation to guidelines
for the practice of pediatric cost-utility analysis (CUA). NICE’s
2004 reference case specifies the use of a generic preferencebased instrument to assess quality of life but proposes no
modifications for pediatric CUA [6]. The 2008 reference case
specifies that:
When necessary, consideration should be given to alternative
standardised and validated preference-based measures of
HRQL, such as the Health Utility Index 2 (HUI 2), that have
been designed specifically for use in children. [7]
HUI is a family of preference-based instruments that comprises two versions, HUI2 and HUI3. A scoring system applies for
children aged 5 years and older and is under development for
children aged 3 to 5 years. It is recommended that where
possible, the HUI3 should be used for primary studies.
No specific instrument was suggested by NICE’s Decision
Support Unit in 2011 [8], and likewise, no specific instrument
was advocated for pediatric CUA in the 2013 guidance [1], which
simply reiterates that
[C]onsideration should be given to alternative standardised
and validated preference-based measures of health-related
quality of life that have been designed specifically for use in
children.
Therefore, from a methodological perspective, there remains
no definitive, clear guidance on which instrument is the most
appropriate to use for measuring health-related quality of life in
children. There is disagreement about the age range to which
generic preference-based instruments can be applied, and there
is also little consensus regarding the extent to which proxy scores
should be used for children across a broad age range between the
“very young” and adolescence [9]. Eiser and Morse [9] describe a
range of generic preference-based instruments. The recently
developed Child Health Utility 9D (CHU-9D) [10] is one of few
child-focused instruments that can claim to meet NICE’s specification of being “designed specifically for use in children” [1]. In
other cases, adjustments have been made to existing adult
instruments such as the EQ-5D youth version questionnaire,
which was derived from the EQ-5D 3 level questionnaire [11].
Published systematic reviews have noted an increase in the
annual number of pediatric [2,4,5,12] evaluations but with respect
to the methods used, Griebsch et al. [4] argue that the limited use
of generic preference-based instruments means that incremental
cost-effectiveness ratios generated by pediatric CUA are not
comparable across diseases and patient groups. Griebsch et al.
[4] conclude that the limited use of generic preference-based
instruments represents either a reflection of how underdeveloped methods are in CUA pediatric practice or a failure of the
guidelines to keep up to date with standards in CUA pediatric
evaluations.
This article reports a systematic literature review with two
distinct objectives:
1. To report how methods within UK pediatric CUAs have
evolved over time, assessing in particular whether methodological and design issues noted previously by Griebsch et al. in
a review of studies to 2004 persist over the period 2004 to 2012.
2. To describe and assess the relationship between pediatric
CUAs in the United Kingdom and the pediatric CUA recommendations set out by NICE, particularly in relation to the
derivation of utility values.
A supplementary objective was to assess whether methods
used in published pediatric CUAs indicate a need for
455
amendments to NICE Technology Assessment methods guidance
to improve consistency and to ensure that the guidelines are in
line with “best practice.”
Methods
Search Strategy
Electronic searches were undertaken using MEDLINE, Embase,
and Cochrane databases for the period from May 2004 to April
2012 and the Paediatric Economic Database Evaluation database
for the period May 2004 to December 2010, which was the most
recent complete year available. An upper age limit of 16 years
was selected to ensure compatibility with the rationale outlined
by Griebsch et al. [4]. Search terms were developed in MEDLINE,
and adapted to Embase, using a combination of Medical Subject
Heading terms and free text. Three groups of search terms related
to 1) children, infants, and pediatric; 2) economic evaluation/
quality of life; and 3) the UK. The focus of interest was children,
for whom there are fewer validated instruments and proxy
measurement is common; therefore, practice is more varied. Full
details of the searches can be found in the online appendices (see
Appendix A in Supplemental Materials found at http://dx.doi.org/
10.1016/j.jval.2014.02.007). Search terms were modified for relevant Cochrane databases.
Selection
All identified studies were screened by three independent
reviewers. First, titles were screened for obvious rejection on
the basis of the exclusion criteria; then, all abstracts were
screened. If there was uncertainty regarding the rejection of the
article, then full text was requested. Inclusion criteria were
defined as follows:
CUA entailing the generation of a QALY score, including
health technology assessment
Analysis includes children aged 16 years and younger and
measures health utility in relation to disease sequelae in this
age group
Includes children in any part of the United Kingdom
English language
Human only
Primary CUA or a combination of systematic review and
primary CUA
Full manuscript publication available
Identified studies that failed to match the inclusion criteria
were excluded. Where the abstract met the inclusion criteria, the
full manuscript was requested. Any differences in opinion
regarding the inclusion of articles were resolved by discussion
between the reviewers. A citation search was undertaken for
publications included in the review to identify any additional
publications that might not have been previously identified.
Assessment and Data Extraction
Data extraction criteria (see Appendix C in Supplemental Materials
found at http://dx.doi.org/10.1016/j.jval.2014.02.007) were developed from checklists for evaluation of adult CUA [13] combined
with criteria from the Paediatric Quality Assessment Questionnaire [14] and the framework adopted by a previous review [4].
Where possible, data extraction queries were framed in a binary or
restricted list format. Methods used for derivation of utility scores
within the economic evaluation were the focus of the review.
456
VALUE IN HEALTH 17 (2014) 454–461
Study Characteristics
Results
After the elimination of duplicates, the search strategy identified
76 titles and abstracts. These 76 articles were retrieved for
assessment, and 41 publications were identified for inclusion in
the final review. A further 2 articles were identified from citation
searches. Data were therefore extracted from 43 articles (see
Appendix B in Supplemental Materials found at http://dx.doi.org/
10.1016/j.jval.2014.02.007).
Table 1 – Study characteristics in relation to the
assessment and valuation of HRQOL.
Source of utility values
n
%
Only generic preference-based described
Generic preference-based þ disease
specific
SG
Not specified
TTO
Expert opinion
Disease specific with utility mapped
Various
23
6
51
13
6
3
3
2
1
1
13
7
7
4
2
2
Utility assessment technique used
n
%
EQ-5D questionnaire
HUI2
SG
EQ-5D questionnaire modified
TTO
HUI3
Not specified
HUI3 modified
IHQL and expert panel
Index of well-being
QWB
None
TTO and VAS
Various
VAS
9
6
6
5
4
3
3
2
2
2
2
1
1
1
1
19
13
13
10
8
6
6
4
4
4
4
2
2
2
2
Utility score derived from
n
%
Child
Adult (not specified as parent)
Not specified
Child and adult
Parent
Various
28
12
3
2
1
1
60
26
6
4
2
2
QOL assessment performed by
n
%
Parents or caregivers
HCPs
Not specified
Self-assessment
Not applicable
Various
16
12
10
8
2
1
33
24
20
16
4
2
EQ-5D, EuroQol five-dimensional; HCP, health care practitioner;
HRQOL, health-related quality of life; HUI, health utilities index;
IHQL, Index of Health-Related Quality of Life; QOL, quality of life;
QWB, Quality of Well-Being Scale; SG, standard gamble; TTO, time
trade-off; VAS, visual analogue scale.
Full study characteristics for all the included articles are available in
a supplementary online file for Web publication; a summary is
presented in Table 1. It was possible to determine details of the study
population in all 43 studies. It was found that 30 studies targeted
children exclusively, while 13 studies also included adults. Overall,
the reporting of the details of the childhood population was poor,
with no explicit definition of upper and lower age range in 23 of the
43 (53%) studies (Table 2). Most of the identified studies contained a
decision-analytic model (38 of 43 studies), and none adopted a purely
societal perspective. The time horizon was justified either explicitly
or by inference in 36 of 43 (80%) studies, and a lifetime horizon was
adopted in 17 of 43 (40%) studies. With respect to objective two, the
evidence indicated conformity to the NICE guidelines that were
applicable at the time each study was published (either the reference
case guidelines from 2004 or 2008) in all aspects of evaluation
unrelated to utility. Perspective was stated explicitly, or easily
inferred, in all but one study, and the perspective selected is that
of the NHS in 36 of 43 (86%) studies. The studies also conformed to
the NICE reference case in terms of time horizon, discount rates, and
probabilistic sensitivity analysis. Therefore, it would appear that
there is evidence of conformity to NICE standards in all aspects of
the identified CUAs that do not pertain to utility measurement.
Critical Assessment of Outcome Measures
It was found that utility estimates were generated from primary
research in 11 of 43 (26%) studies. Two CUAs were difficult to
classify: Martin et al. [15] provide evidence of utility generation in a
separate publication by the same authors, whereas Walker et al. [16]
offer insufficient detail on utility sources to enable classification.
The majority of CUAs obtained utility scores by proxy using either
parent or health care professionals, and more than 25% of the
studies applied utility scores derived from adults. Wide variation
with utility assessment was observed with respect to the use of the
standard gamble approach, the EQ-5D questionnaire (modified or
unmodified), and the use of various versions of the HUI.
Although 11 of the 43 (26%) CUAs used primary research (see
Appendix D in Supplemental Materials found at http://dx.doi.org/
10.1016/j.jval.2014.02.007), only 1 study, Baguelin et al. [17],
applied utility scores to children’s own self-assessed/reported
health states in an 11 to 18 year age group (Table 2); completion
in younger children was by proxy. Those CUAs that focused on
both adults and children did not report different methods of
generating utility scores and of the 14 CUAs that derive utility
scores from adults, 5 do not highlight the limitations of this
approach (Table 2).
Discussion
In areas unrelated to utility assessment, the review shows that
the methods applied within UK-based pediatric CUA conform to
the NICE reference case guidance, but with utility assessment,
there is wide variation in methodological practice.
There has been a growth in the use of preference-based
instruments in children, but NICE’s suggestion to use the HUI2 in
2008 is matched in application by no increase in its use, but instead
an increase in the use of the EQ-5D questionnaire. The 2013 NICE
guidance calls for instruments specifically developed for use with
children; the review has shown that instruments such as the CHU9D have never been used; and while the EQ-5D questionnaire was
modified in four CUAs, the modified version does not relate to the
EQ-5D youth version questionnaire. It should, however, be
acknowledged that with newly developed instruments such as
the CHU-9D, there is always a time lag between application of the
instrument within studies and subsequent publications.
Table 2 – Summary of studies identified as meeting the inclusion criteria.
First author
(year)
Principle
funding
source?
Baguelin
(2010) [17]
DOH
Health intervention
Vaccination against influenza
Definition of
child (age
range)
specified?
(yes/no)
Age range
of patient
group (y)
QOL assessed
by
Utility values
derived via
Utility
value
elicited
for
Describes
limitations of
available evidence
with respect to
utility values
No
o1–10
Proxy (parent)
Child
No
11–18
Self-assessment
Self-assessment
Modified EQ-5D
questionnaire
Modified EQ-5D
questionnaire
VAS
NIHR
Hearing screening
NA
Barton (2006)
[25]
Bond (2009)
[26]
Brown (2009)
[27]
MRC and
NGO
NIHR
Cochlear implants
NA
3 and 6
Cochlear implants
Yes
?
Extracorporeal membrane
oxygenation (ECMO)
Christensen
(2010) [28]
Claxton
(2004) [29]
Colquitt
(2011) [30]
Connock
(2006) [31]
Cottrell
(2008) [32]
Craig (2011)
[33]
Dretzke
(2011) [34]
Epps (2005)
[35]
Fayter (2007)
[36]
Industry
NIHR
Treatment of children born
short for gestational age
Treatment of UTIs
NIHR
NIHR
Frew (2007)
[37]
Adult
Self-assessment
Proxy (health
care provider)
Proxy (parent)
HUI3
TTO
Adult
No
Modified HUI3
Child
Yes
1, 8
Proxy (parent)
Modified HUI3
Child
No
Yes
1–18
Proxy (health
care provider)
Child
No
No
NS
Self-assessment
Adult
No
Yes
NS
Self-assessment
Expert opinion
(based on HUI2
health states)
EQ-5D
questionnaire
Index of Well-being
Adult
No
Bone-anchoring hearing aids
Yes
NS
NA
HUI3
Adult
Yes
No
Birth cohort
NS
TTO
Adult
Yes
No
NS
Proxy (parent)
SG
Child
No
No
5þ
NS
Child
Yes
No
NS
Self-assessment
IHQL and expert
panel
TTO
Adult
Yes
Yes
4–19
Child
Yes
NIHR
Enzyme replacement therapy for
type I Gaucher’s disease
Attention deficit/hyperactivity
disorder
Comparison of growth screening
referral strategies
Adalimumab and infliximab for
Crohn’s disease
Hydrotherapy for juvenile
rheumatoid arthritis
Monitoring of growth
No
4þ
Yes
?
Monitoring of obesity
Antiepileptic drugs
Yes
11þ
3–18
Child
and
adult
Adult
Child
Industry
NIHR
NIHR
NIHR
Proxy (parent)
NS
NA
Proxy (health
care provider)
EQ-5D
questionnaire
IHQL and expert
panel
None
Expert opinion
(based on health
states from
VALUE IN HEALTH 17 (2014) 454–461
Bamford
(2007) [24]
o18
hospitalized
4–6
Child
Yes
continued on next page
457
458
Table 2 – continued
First author
(year)
Principle
funding
source?
NIHR
Karnon
(2008) [41]
King (2006)
[42]
Industry
Martin (2009)
[15]
Industry
Melegaro
(2004) [43]
DOH
Nuijtjen
(2007) [44]
Industry
Petrou (2010)
[45]
Pitt (2006)
[46]
Prasad (2009)
[47]
Price (2011)
[48]
NIHR and
DOH
NIHR
Punekar
(2010) [49]
Industry
Rautenberg
(2012) [50]
Industry
DOH
NIHR
Industry
NIHR
Industry
NIHR
Definition of
child (age
range)
specified?
(yes/no)
Age range
of patient
group (y)
QOL assessed
by
Utility values
derived via
Utility
value
elicited
for
Describes
limitations of
available evidence
with respect to
utility values
Child
Yes
Pimecrolimus in atopic
dermatitis
Tacrolimus ointment in atopic
dermatitis
Vaccination for rotavirus
gastroenteritis
Yes
2–16
Proxy (parent)
modified EQ-5D
questionnaire)
SG
No
NS
Proxy (parent)
SG
Child
No
Yes
40–5
HUI2
Child
No
Oral deferasirox in patients with
chronic iron overload
Methylphenidate in
combination with behavioral
therapy
Vaccination with RIX4414 to
prevent rotavirus
gastroenteritis
Universal vaccination with
pneumococcal conjugate
vaccine
No
NS
Proxy (parent or
caregiver—
unclear)
NS
QWB
Adult
No
Yes
6
Proxy (parent)
SG
Child
Yes
Yes
40–o18 mo
18 mo to 5 y
Modified EQ-5D
questionnaire
Child
Yes— develops own
data
No
o6 mo, 6–
11 mo, and
5 y age
bands
r35 wk of
gestation
Proxy (GP)
Proxy (hospital
physician)
Various
Various
Yes
Proxy (parent)
HUI2
Child
No
Palivizumab for prevention of
respiratory syncytial virus
(RSV)
Topical intranasal steroids for
otitis media
Pimecrolimus in atopic
dermatitis
Treatment of attention deficit/
hyperactivity disorder
Controller therapy in asthma
and add-in therapy for
uncontrolled asthma
Infliximab in children with
severe active Crohn’s disease
Racecadotril plus oral
rehydration solution (ORS) vs.
ORS alone
Yes
Various
Yes
4–11
Proxy (parent)
HUI3
Child
No
No
NS
Proxy (parent)
SG
Child
No
No
NS
Proxy (parent)
SG
Child
No
Yes
12–80
NS
EQ-5D
questionnaire
Child
No
Yes
6–17
Self-assessment
EQ-5D
questionnaire
Expert opinion
Adult
Yes
Modified EQ-5D
questionnaire
Child
Yes
No
40–o18 mo
18 mo to 5 y
Proxy (hospital
physician)
Proxy (GP)
Proxy (hospital
physician)
Child
Child
No
Yes
continued on next page
VALUE IN HEALTH 17 (2014) 454–461
Garside
(2005) [38]
Healy (2011)
[39]
Jit (2007) [40]
Health intervention
Renfrew
(2009) [51]
Enhanced staff contact
promoting breast-feeding
Birth cohort
weighing
o2500 g
Birth cohort
weighing
o2500 g
From birth
to death
EQ-5D
questionnaire
Proxy (hospital
physician)
EQ-5D
questionnaire
Child
Yes
Other
QWB
No
TTO and VAS
Child
and
adult
Child
Yes
EQ-5D
questionnaire
HUI2
Adult
Yes
Parent
No
TTO
NS
NS
NS
Yes— develops own
data
NA
Rice (2010)
[52]
NIHR
Enhanced staff contact
promoting breast- feeding
No
Simpson
(2005) [53]
?
Screening for cystic fibrosis
No
Summerfield
(2010) [54]
?
Bilateral vs. unilateral cochlear
implants
Yes
6
Takeda (2010)
[55]
van Hoek
(2012) [56]
NIHR
Growth hormone in short
stature children
Vaccination program against
varicella or varicella and
herpes zoster
Adjunctive therapy for children
with Lennox-Gastaut
Omalizumab plus high-dose
inhaled corticosteroids (ICS)
and long-acting beta agonist
(LABA) vs. ICS plus LABA
alone
Palivizumab prophylaxis against
RSV vs. standard care in
infants
No
7–10
No
NS
Proxy (experts
and parents of
children
without
hearing
difficulties)
Proxy (study
nurse)
(Proxy) parent
No
NS
NS
Yes
6–11
DOH
Verdian
(2010) [57]
Walker (2011)
[16]
Industry
Wang (2008)
[58]
NIHR
Wang (2011)
[22]
NIHR
Whiting
(2006) [59]
Wilson, Price
(2010) [60]
Wilson, Sims
(2010) [61]
Yao (2006)
[62]
NIHR
NS
Yes
428 wk of
gestational age
Proxy (parent)
HUI2
Child
Palivizumab prophylaxis against
RSV in high-risk infants
No
r24 wk to
Z35 wk
of
gestational age
Proxy (parent)
HUI2
Child
NIHR
Diagnostic testing for UTI
No
o5
Self-assessment
Index of Well-being
Adult
Yes
NIHR
Add-on therapies to ICS for
asthma
Initial asthma controller therapy
No
12–80
NS
Child
No
No
12–80
NS
Child
No
Yes
o18
NS
EQ-5D
questionnaire
EQ-5D
questionnaire
NS
NS
Yes
NIHR
NIHR
MMF, MPS, and sirolimus for
renal transplant graft
rejection
VALUE IN HEALTH 17 (2014) 454–461
Proxy (hospital
physician)
DOH, Department of Health; EQ-5D, EuroQol five-dimensional; GP, general practitioner; HUI, health utilities index; IHQL, Index of Health-Related Quality of Life; MMF, mycophenolate mofetil;
MPS, mycophenolate sodium; MRC, Medical Research Council; NA, not applicable; NGO, nongovernmental organization; NIHR, National Institute for Health Research; NS, not specified; QWB,
Quality of Well-Being Scale; SG, standard gamble; TTO, time trade-off; UTI, urinary tract infection; VAS, visual analogue scale.
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VALUE IN HEALTH 17 (2014) 454–461
With almost every study identified it was apparent that there
is a paucity of utility data in children, which raises an important
issue about the allocation of research funding. Given this wide
issue of data unavailability, it is recommended that future
research funding be targeted toward high-quality primary
research studies that focus on generating utility data directly
from children instead of relying on reviews of poor evidence.
Although this review was focused on children rather than
adolescents, findings have shown that there is little consensus in
the literature on the upper age range of childhood, with ages
between 16 and 24 years considered in different contexts
[4,18–20]. Birth cannot be assumed the starting age for childhood;
for example, different gestational ages are used by three respiratory syncytial virus studies [21–23]. With this in mind, it should
not be recommended that guidance specify an age range of
childhood because such a definition varies according to the
disease context and the type of health care provision being
evaluated. In more than half of our identified studies, the age
range for childhood was not reported, so the assumed point of
transition from childhood to adulthood is not known. This creates
challenges when attempting to use published data for long-term
decision-analytic modeling of treatment, and these challenges
need to be considered when a lifetime horizon is recommended.
So, rather than specifying an age range for childhood, it is instead
recommended that published pediatric CUAs define, at the very
least, the age range they have used for children.
This review has compared the practice of CUA within the
United Kingdom against the NICE reference case guidance. A
limitation of this approach is that some of the CUAs included in
the review have not been conducted to inform NICE recommendations and thus there is no reason why they would conform to
NICE guidance. We believe that the strength of economic evaluation for decision making rests on consistency in methodology. It
is noteworthy that almost all the CUAs identified in this review
follow NICE guidance in areas unrelated to utility data regardless
of their objectives in relation to NICE; for example, 57% of the
identified CUAs use a discount rate of 3.5% for effects, but there is
no similar consistency for the derivation and application of utility
scores. If economic evaluation results are to be used to inform
resource allocation decisions across different disease and treatment contexts, then it is fundamental that we strive for consistency in methods in all areas, including assessment of utility
scores. It is recommended that future research funding be
focused on high-quality methodological studies in children and
on studies that generate utility data for childhood populations.
This will help move forward methods in this underdeveloped
area, which will, in turn, help organizations such as NICE achieve
the consistency that is required.
Source of financial support: No funding received.
Supplemental Materials
Supplemental Materials accompanying this article can be found
in the online version as a hyperlink at http://dx.doi.org/10.1016/
j.jval.2014.02.007 or, if a hard copy of article, at www.valuein
healthjournal.com/issues (select volume, issue, and article).
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