A Review of the Methods Used to Generate Utility Values in NICE Technology Assessments for Children and Adolescents.

Abstract

This review summarizes and critically examines methods used to generate utilities for child and adolescent health states in previous National Institute for Health and Care Excellence (NICE) technology assessments (TA) and highly specialized technology (HST) evaluations. We identified all NICE TA and HST evaluations in which the licensed indication for the technology included people younger than 18 and included in the review all evaluations using a cost-utility analysis. The review includes 40 TA and HST evaluations. Most assessments generated utility values with the EQ-5D scored using the adult version of the EQ-5D either exclusively (n= 16) or alongside other utility measures and direct elicitation methods of patient own utility (n= 17), although 7 did not use the EQ-5D. Eight assessments used both the EQ-5D child- and adolescent-specific preference-based measures: Health Utilities Index Mark 2 (n= 6), child- and adolescent-specific preference-based measure for atopic dermatitis (n= 1), and youth version of the EQ-5D (EQ-5D-Y) valued using the adult EQ-5D value set (n= 1) or generated using mapping and valued using the adult EQ-5D value set (n= 2). Some cost-utility analyses used age adjustment (utility subtractions, weights, and published mapping formulae) from the adult EQ-5D UK population norms to reflect the general population or disease-free health for children and adolescents (n= 9), and 1 assessment assumed full health (utility value of 1). The review found limited use of child and adolescent population-specific measures to generate health state utility values for children and adolescents in NICE technology assessments. Often assessments involve the use of an adult-specific measure to reflect the health of children.