The Pediatric Quality Appraisal Questionnaire: An Instrument for Evaluation of the Pediatric Health Economics Literature


  • Wendy J. Ungar MSc, PhD,

    1. Department of Population Health Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada;
    2. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Maria T. Santos MHSc

    1. Department of Population Health Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada;
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Wendy Ungar, Scientist, Population Health Sciences, Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. E-mail:


Objectives:  Currently there is no tool available to adequately appraise the quality of the pediatric health economics literature. A comprehensive pediatric-specific instrument would be valuable in informing allocation decisions related to pediatric interventions and services. The goal of this study was to develop the Pediatric Quality Appraisal Questionnaire (PQAQ).

Methods:  A draft instrument was constructed from published checklists and questionnaires. New questions pertaining to the pediatric population were incorporated. An expert panel reviewed the draft instrument and the proposed scoring scheme for face and content validity. A revised version was pilot tested by three independent appraisers. After addressing discrepancies in scores, a final version was created and subjected to interrater and test–retest reliability assessment.

Results:  The 57 items in the final PQAQ were mapped onto 14 domains: economic evaluation, comparators, target population, time horizon, perspective, costs and resource use, outcomes, quality of life, analysis, discounting, incremental analysis, sensitivity analysis, conflict of interest, and conclusions. Among the 57 items, 46 have response options that are scored from 0 to 1. Interrater reliability was 0.75 (95% confidence interval [CI] 0.66–0.81) and test–retest reliability was 0.92 (95% CI 0.71–0.98).

Conclusions:  The PQAQ is a comprehensive instrument demonstrating face and content validity and strong interrater and test–retest reliability in the appraisal of pediatric economic evaluations. This tool will be valuable to health economists, methods researchers, and policy decision makers involved in allocation decisions for pediatric health care.