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ABSTRACT: 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.
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ABSTRACT: To undertake a cost effectiveness analysis comparing conservative management, surgery, and radiosurgery for treating small-to-medium (1-20mm) sized vestibular schwannomas. Model based economic evaluation using individual-level data from a Birmingham-based longitudinal patient database, and from published sources. Both a decision-tree and state transition (Markov) model were developed, from a NHS (National Health Service) perspective. Sensitivity analyses were also carried out. Secondary care treatment for patients with small-to-medium sized vestibular schwannomas. Three hypothetical cohorts of adult patients receiving either conservative management, radiosurgery or surgery treatment, aged 58 years as starting age within model. Cost-effectiveness based on cost per quality-adjusted life year (QALY). Conservative management is the preferred strategy for the treatment of small-to-medium sized vestibular schwannomas. Conservative management is both cheaper (-£722 and -£2,764) and more effective (0.136 and 0.554 QALYs) than both radiosurgery and surgery respectively. A conservative strategy can therefore be considered as highly cost effective. This result is sensitive to the assumed quality of life parameters in the model. Sensitivity analysis suggests that the probability of a conservative strategy being the most cost-effective approach compared to surgery and radiosurgery at a willingness to pay of £20,000/QALY gained, is 80% and 55% respectively. A conservative approach is the preferred strategy for treatment of small-to-medium vestibular schwannomas. This result is sensitive to quality of life values used in the analysis. More research is required to assess the impact of treatment upon patients' health-related quality of life over time. This article is protected by copyright. All rights reserved.
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