Systematic review of health state utilities in children with asthma

Background: Asthma exacerbations affect quality of life for children with asthma. A cost-utility analysis was performed alongside the PLEASANT clinical trial to assess the cost-effectiveness of a letter intervention in preventing and lessening exacerbations in school-aged children at the start of a new school term. The economic analysis relied on published literature for health utilities estimates as no patient reported outcome measures were collected in the trial. Objective: To identify preference-based utility values for children with day-to-day asthma symptoms (baseline utility) and children experiencing an asthma exacerbation, and to review the appropriateness of the utility values to be used in the PLEASANT economic analysis. Methods: A systematic review was performed in five electronic databases (Ovid MEDLINE, The Cochrane Library, EMBASE, ECONLIT and SCHARR Health Utilities Database) up to 5th July 2014 to identify studies that report preference-based utility values in children with asthma. Results were summarised narratively and utility data were assessed for quality, relevance to the economic analysis and compliance with the NICE reference case. Results: A total of 927 studies were identified from the search and 14 studies which met the inclusion criteria were included. Health utilities were elicited using various outcome measurements. EQ-5D was used in 5 studies (35.7%), HUI, PAHOM and direct valuation using vignettes were each reported in 2 studies (14.3%). Three (21.4%) studies estimated utility values from mapping between condition specific measures and the EQ-5D. None of the studies directly measured health utilities in children with asthma exacerbation using a preference-based measure. Conclusions: There is a lack of robust estimates on utility decrement in children with asthma exacerbation. Future studies in children with asthma should incorporate collection of health state utilities into the study design, taking into account the ethical and methodological considerations of quality-of-life assessment during exacerbation.