A review of the methods used to generate utility values in NICE technology assessments for children and adolescents

Objective: This review summarises and critically examines methods used to generate utilities for child and adolescent health states in previous NICE (National Institute for Health and Care Excellence) technology assessments.

Methods: We identified all NICE Technology Appraisal (TA) and NICE Highly Specialised Technologies (HST) guidance where the licensed indication for the technology included people under 18 years.

Results: The review includes 40 NICE technology assessments. Most assessments generated utility values using 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) and seven did not use the EQ-5D. Ten assessments used both adult and children population-specific measures: Health Utilities Index Mark 2 (n=6); a children and adolescents specific preference-based measure for atopic dermatitis (n=1); the youth version of the EQ-5D (EQ-5D-Y) generated using mapping and valued using the UK EQ-5D adult tariff (n=2), and the EQ-5D-Y using the EQ-5D adult tariff (n=1). The cost-effectiveness analyses used age adjustment (utility subtractions, weights and published mapping formulae) from adult EQ-5D UK population norms to reflect general population or disease-free health for children and adolescents (n=9), and one assessment assumed full health (utility value of 1).

Conclusion: The review found very limited use of child and adolescent population-specific measures to generate health state utility values for children and adolescents in technology assessments submitted to NICE. Often they use an adult specific measure to reflect the health of children.