Is the UK NICE "reference case" influencing the practice of pediatric quality-adjusted life-year measurement within economic evaluations?

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.

A comparison of healthcare resource use for rotavirus and RSV between vulnerable children with co-morbidities and healthy children: a case control study.

OBJECTIVE: To quantify the differences in hospital length of stay (LOS) and cost between healthy and vulnerable children with cystic fibrosis (CF), insulin-dependent diabetes mellitus (IDDM), cancer, and epilepsy who contract rotavirus (RVGE) or respiratory syncytial virus (RSV). METHODS: Hospital Episode Statistics (HES) data were collected for England, for children <5 years old, admitted between April 2001 and March 2008, using ICD-10 codes for RVGE and RSV. Cases were identified as having RVGE and/or RSV plus CF, IDDM, cancer, or epilepsy. Healthy controls had RVGE and/or RSV only, additional controls had eczema only. Cost, hospital LOS, and demographics were collected. RESULTS: Four hundred and eighty-six (0.5%) cases and 101,784 (99.5%) healthy controls were admitted with RVGE or RSV, with 17,420 eczema controls. RVGE was present in 153 (31.5%) cases and 7532 (7.4%) healthy controls, and RSV in 333 (68.5%) cases and 94,252 (92.6%) healthy controls. Cases were older (1.1 years, SD = 1.3 years), had greater LOS (9.9 days, SD = 19.9), and cost more (£3477, SD = £7765) than healthy controls (age = 0.2, SD = 0.5, p < 0.001; LOS = 1.9 days, SD = 3.1, p < 0.001; cost = £595, SD = £727, p < 0.001). Cost for cases was 6-times greater than healthy controls (p < 0.001). Controls had a 0.3 day greater LOS (p < 0.001) with RSV, but a £17 (p = 0.085) lower mean cost than RVGE. CONCLUSION: RVGE and RSV are more serious diseases in vulnerable children, requiring more intense resource use. The importance of preventing infection in vulnerable children is underlined by hygiene and appropriate isolation and vaccination strategies. When universal vaccination is under consideration, as for rotavirus vaccines, evaluation of a vaccination programme should consider the potentially positive impact on vulnerable children. LIMITATIONS: Limitations of the study include a dependency on accurate coding, an expectation that patients are identified through laboratory testing, and the possibility of unidentified underlying conditions affecting the burden.

Rotavirus, respiratory syncytial virus and non-rotaviral gastroenteritis analysis of hospital readmissions in England and Wales.

AIM: To quantify readmissions with infectious diseases and differences in readmission patterns. METHODS: Using the CHKS database, children <5 years admitted to hospital in England and Wales, between 2000 and 2008, with rotavirus (RV), respiratory syncytial virus (RSV) or non-rotaviral gastroenteritis (NRV) were identified. All admissions within a 30-day prior period were similarly identified, and the proportion of readmissions was calculated. RESULTS: There were 365,693 admissions for RV, RSV and NRV; 17.2% were readmissions. In 36% of cases, the cause of the prior admission was also RV, RSV or NRV, with 64% having a different prior diagnosis. The majority of readmissions were within 5 days of their prior admission, the majority of those with RV (n = 2,566/58.7%) within 3 days, NRV (n = 11 326/53.5%) within 4 days and RSV (n = 18 811/50.2%) within 9 days of prior discharge. Readmission for RV was associated with greater LOS than RSV (p < 0.001) and NRV (p < 0.001), while cost per admission was greater for RV compared to RSV (p < 0.001) and NRV (p < 0.001). CONCLUSIONS: Thirty-six percent of readmissions indicated discharge without resolution from the first admission; nosocomial infection needs to be considered as a cause in the other. Although RSV represented the largest readmission group, higher costs and longer LOS were associated with RV.

Burden on UK secondary care of rotavirus disease and seasonal infections in children.

OBJECTIVE: Rotavirus is a common infection affecting children under 5 years, which leads to a significant disease burden. This burden is potentially exacerbated by the seasonality of rotavirus, particularly in the context of the seasonality of other common childhood infections. The primary study objective was to describe the pattern and burden of seasonal infections amongst children under 5 years of age with particular attention placed on rotavirus and other gastrointestinal infections. METHODS: A retrospective analysis of all routine inpatient data relating to selected seasonal infections in the UK was conducted between 2001/02 and 2007/08 using data from Capse Healthcare Knowledge Systems (CHKS, England, Northern Ireland and Wales) and Information Services Division (ISD, Scotland). Admissions with selected diagnoses were extracted based on International Classification of Diseases (ICD)-10 coding. All episodes were processed using a HRG grouper and costs applied according to the NHS National Tariff. RESULTS: In the financial year 2007/08, the total number of admissions in the UK for children under 5 years for the selected seasonal infections was 64,879 of which 32,126 admissions were associated with gastrointestinal infections including rotavirus gastroenteritis (RVGE). Seasonal peaks of gastrointestinal infections and RVGE occurred in the spring quarter and respiratory syncytial virus (RSV) and influenza in the winter quarter. Admissions for gastrointestinal infection including RVGE accounted for 35 003 bed days with 9922 due to RVGE. The total cost for admissions involving a diagnosis of seasonal infection was £56 million. Of this, it was estimated that infections with an ICD-10 classification of rotavirus represented a cost of £8.6 million. CONCLUSION: Rotavirus contributes to the significant burden that seasonal infections place on inpatient paediatric resources during the winter and spring months. This study may be limited by issues of clinical coding and the infrequency of confirmatory microbiological testing in real-world practice. Vaccination might be considered as a means of reducing this clinical and economic burden particularly where long-term effectiveness and ease of administration are proven.