Characteristics and quality of pediatric cost-utility analyses.

Purpose: Measuring utility for cost-utility analysis (CUA) is challenging in children. The objectives were to characterize pediatric CUAs, appraise their quality, and identify determinants of higher quality.

Methods: Descriptive data were imported from the PEDE database for 305 pediatric CUAs published from 1997 to 2009, and quality was rated using the Pediatric Quality Appraisal Questionnaire (PQAQ) in 213 studies. The impact on quality of publication year, journal type, and whether utility was measured was analyzed using multiple regression.

Results: CUAs increased over time and the largest proportion was from North America (38%). Children aged 1-12 years (39%) and preventative interventions (51%) were studied most frequently. Whereas a societal perspective was most common in papers published before 2007 (49%), a third-party payer perspective was subsequently most frequent (63%). Utility was measured prospectively in 8% of studies. Domains that demonstrated the poorest quality were Perspective, Costs and resource use, Outcomes, Analysis, Incremental analysis and Conflict of interest. Quality increased significantly over time for most domains and was greater in studies published in methods/health economic journals.

Conclusions: The quality of pediatric CUAs is increasing. Few studies ascertain utility prospectively, suggesting the need for better instruments for pediatric health state valuation and measurement.