Apr 04, 2025
How utility outcome used in the cost-effective analysis of the intervention during pregnancy: A scoping review protocol
- Yoshiko Yamamoto1,
- Tatsuki Ishizuka2,
- Motoko Tanaka1
- 1Department of Health Policy, National Center for Child Health and Development;
- 2Major in Public Health, Sport and Health Sciences, Graduate School of Health Management, Keio University
Protocol Citation: Yoshiko Yamamoto, Tatsuki Ishizuka, Motoko Tanaka 2025. How utility outcome used in the cost-effective analysis of the intervention during pregnancy: A scoping review protocol. protocols.io https://dx.doi.org/10.17504/protocols.io.yxmvm9d2ol3p/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: March 07, 2025
Last Modified: April 04, 2025
Protocol Integer ID: 123960
Keywords: pregnant women, cost-utility analysis, health-related QOL, scoping review, important health outcome measure in hta, important health outcome measure, adopting health technology assessment, pregnancy method, including pregnant women, health technology assessment, utility analysis of the intervention, medical cost, pregnancy, increased medical cost, utility value in the study, scoping review protocol background, review along with the jbi methodology, effective analysis of the intervention, quality of life, eligible study, utility outcome, intervention, effective analysis, adjusted life year, assessment, utility analysis, health
Abstract
Background
Increased medical costs and the pressure to allocate limited resources efficiently have resulted in an increasing number of countries adopting Health Technology Assessment (HTA) systems. Quality-adjusted Life Years (QALYs) is an important health outcome measure in HTA. However, there have been criticisms about QALYs; for example, it is not sensitive to the population with specific concerns, including pregnant women. Because pregnant women receive interventions for their children and have anxiety about their unborn child, measuring only their health-related quality of life in an ordinary way may not be appropriate. Therefore, we will conduct the scoping review with the aim of a comprehensive understanding of the overall picture of the current utilization of the utility among pregnant women.
Review questions
To understand how to estimate and utilize the health-related quality of life in the cost-utility analysis of the intervention during pregnancy
Methods and analysis
We will conduct this review along with the JBI methodology for scoping reviews. After a systematic search on MEDLINE, EMBASE, International HTA Database, SCOPUS and Web of Science, we are doing title/abstract and full-text screening along with inclusion criteria based on PCC. From eligible studies, we will extract variables such as estimation and usage of utility, study perspective, time horizon and limitation when using utility value in the studies. Extracted variables will be narratively analyzed.
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Troubleshooting
Background
Increased medical costs and the pressure to allocate limited resources efficiently have resulted in an increasing number of countries adopting health technology assessment systems. Several countries adopted QALYs as an outcome measure that enables the comparison of interventions from different fields. The generic preference-based measure needed to estimate QALYs and EQ-5D or SF-6D is one such typical questionnaire. However, such generic ones have a limited number of dimensions and are not sensitive to the change in health-related quality of life among the population with specific concerns. Especially among women around the prenatal, perinatal or postnatal period, they have anxiety about their unborn child, not for themselves, which may affect the health-related quality of life of pregnant women. In addition, pregnant women often receive interventions, not for their own diseases but for the health of their children, so in such cases, health-related quality of life of only women may not be appropriate as the outcome measure of such interventions. However, there is a paucity of discourse surrounding the utility of pregnant women, and there is an absence of consensus on how to estimate their utility or how it should be employed. Therefore, we will conduct the scoping review with the aim of a comprehensive understanding of the overall picture of the current utilization of the utility among pregnant women.
Objective
The aim of this scoping review is to explore the current usage of the utility in the interventions during pregnancy.
Review questions
In the cost-utility analysis of the intervention during pregnancy:
1. How is the utility outcome estimated and used
2. Which questionnaire the authors used
3. Whose utility was included, and what length of time horizon was adopted
4. What the authors pointed out as its limitations
Methods and analysis
This scoping review is conducted along with the JBI methodology for scoping reviews.
Inclusion criteria
Population:
Pregnant women of any age and have any health condition; healthy, with obstetric complications, with medical complications or with any risk factors of developing any complications
Concept:
Cost-utility analysis that evaluates any interventions during pregnancy. Intervention should improve women’s and children’s health outcomes. Outcomes should include utility values such as
Quality Adjusted Life Years (QALYs). We limit the publication year to the last five years (2020-2024) because we would like to collect the latest trends in the utilization of utility and the estimation methods of utility values.
Context:
OECD countries
Exclusion criteria
The intervention aims at conception.
The intervention in the pre-pregnancy period.
Any kind of reviews, but we will refer to the included articles if we find systematic reviews.
Type of sources
Cost-utility analysis but not exclude named cost-effective analysis that used utility outcomes alongside effectiveness outcomes.
Conference abstracts, any kinds of reviews, and qualitative studies were excluded.
Search strategy
Searching Database:
systematic search on PubMed, EMBASE, International HTA Database, SCOPUS, Web of Science
Search strategies on MEDLINE (Ovid), Embase, SCOPUS and Web of Science are presented in the attached file. We construct these strategies based on several filters of economic evaluation and pregnancy.
Language restriction:
None
Study selection
According to the inclusion and exclusion criteria, we will conduct title/abstract screening by two reviewers, and if there are any conflicts, discuss to resolve them.
Then, we will conduct full-text screening by two reviewers. If there are any conflicts, discuss to resolve them.
Data extraction
We will extract the basic information such as publication year, authors, and name of the journal. We will collect data about the target population, intervention, method of analysis, mother’s and children’s (if applicable) utility measurement, used questionnaire, method of estimation, study perspective, time horizon, country/region, ICER and limitation when using utility value.
Data analysis and presentation
Available articles are categorized by type of intervention, method of analysis, utility measurement, or whose utility is included.
The result would be analized literally and will not estimate quantitative value.
Ethics and dissemination
We utilize all published data. The ethical approval is not necessary.
Patient and public involvement
Not applicable
Funding statement
This study received no external funding.
Conflict of Interest declarations
All the authors do not have any conflict of interest.
Protocol references
- Rand LZ, Melendez-Torres GJ, Kesselheim AS. Alternatives to the quality-adjusted life year: How well do they address common criticisms? Health Serv Res. 2023 Apr;58(2):433-444. doi: 10.1111/1475-6773.14116. Epub 2022 Dec 28. PMID: 36537647; PMCID: PMC10012222.
- Keller E, Chambers GM. Valuing infertility treatment: Why QALYs are inadequate, and an alternative approach to cost-effectiveness thresholds. Front Med Technol. 2022 Dec 23;4:1053719. doi: 10.3389/fmedt.2022.1053719. PMID: 36619344; PMCID: PMC9822722.
- Hulst SM, Brouwer W, Mol BW, van den Akker-van Marle ME. Challenges in economic evaluations in obstetric care: a scoping review and expert opinion. BJOG. 2020 Oct;127(11):1399-1407. doi: 10.1111/1471-0528.16243. Epub 2020 May 5. PMID: 32277547; PMCID: PMC7539957.