QALY weights for neurosensory impairments in pediatric economic evaluations: case studies and a critique

Abstract

The use of utility weights for the calculation of quality-adjusted life years is particularly problematic for pediatric health states. This article reviews variability in utility weights for intellectual disability and permanent hearing loss in economic evaluations of newborn screening and childhood immunizations. Utility weights for severe intellectual disability ranged from 0.06 to 0.74. Most studies either did not vary these utility weights in sensitivity analyses or assumed low variability; consequently, the robustness of cost–effectiveness estimates was not fully assessed. Two recently published catalogs of utility weights for pediatric health states also show wide divergences in estimates. More work is needed to establish measures of health utilities for childhood health states in order to allow for comparable assessments of pediatric interventions.

Keywords::

• cost–effectiveness analysis
• cost–utility analysis
• immunizations
• meningococcal vaccine
• newborn screening
• pneumococcal vaccine
• quality-adjusted life years

Acknowledgements

Kara Lamarand provided research assistance. Mick Tilford provided very helpful comments on an earlier version of the manuscript. An earlier version of this paper was presented at the International Society of Quality of Life Research (ISOQOL) conference, New Orleans, Louisiana, USA on 27 October 2009.

Financial & competing interests disclosure

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Canadian Agency for Drugs and Technologies in Health, Kaiser Permanente Northwest or Health Utilities Incorporated. It should be noted that David Feeny has a proprietary interest in Health Utilities Incorporated, Dundas, Ontario, Canada. Health Utilities Incorporated distributes copyrighted Health Utilities Index (HUI) materials and provides methodological advice on the use of HUI. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.