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Sunday, 15 October 2006


Joseph A. Ladapo, BA, Harvard University, Cambridge, MA, Peter Neumann, ScD, Tufts-New England Medical Center, Boston, MA, and Lisa A. Prosser, PhD, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA.

Purpose: Cost-utility analysis (CUA) has long been applied to economic evaluations of adult health interventions. However, with increasing frequency, researchers are implementing cost-utility analyses in pediatric populations. Because these studies can influence resource allocation decisions, comparability of methods used to conduct CUAs is a key issue for policy makers. We analyze these methods and compare the cost-utility ratios of pediatric and adult health interventions by classifying them by disease prevention stage, health intervention category, and primary disease type.

Methods: Using a CUA database developed by the Harvard Center for Risk Analysis, we compare the characteristics of studies of pediatric and adult health interventions. Descriptive characteristics include intervention type, prevention stage, and financial sponsor; methodological approaches include time horizon, discount rate and preference source. Using the Wilcoxon rank-sum test, we compare median cost-utility ratios of pediatric and adult health interventions.

Results: The final dataset includes 35 pediatric and 491 adult studies, resulting in a total of 91 pediatric and 1498 adult cost-utility ratios. In pediatric studies, the largest categories for intervention type are immunizations and pharmaceutical interventions, which each account for 17% of studies. Pharmaceutical interventions account for 36% of adult studies, followed by surgical procedures (12%) and screening measures (10%). In studies that use a single source of preferences to determine quality-of-life weights, preferences most frequently come from the author in pediatric studies (29%) and the patient in adult studies (14%). Community and clinician preferences are also commonly used in both pediatric and adult analyses. Almost all studies with available discount rate data use the same discount rate for costs and benefits, which is most commonly 3%. The overall median cost-utility ratio is $7,300/QALY in child studies (95% CI: $4,800/QALY, $24,000/QALY), and $26,000/QALY in adult studies (95% CI: $23,000/QALY, $29,000/QALY); child studies tend to have lower published cost-utility ratios than adult studies even when categorized.

Conclusions: CUAs of pediatric and adult health interventions vary across descriptive characteristics, but are largely similar methodologically. Published pediatric cost-utility ratios tend to be lower, and this relationship persists throughout different prevention stages, interventions, and diseases. When allocating resources, policy makers who use economic analysis as a decision-making aid can take some comfort in the methodological similarities between pediatric and adult studies.

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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)