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About Sickkids
About SickKids

Wendy Ungar, PhD

Research Institute
Senior Scientist
Child Health Evaluative Sciences

Director, Technology Assessment at SickKids (TASK)
Research Institute

University of Toronto
Professor
Health Policy, Management and Evaluation

Chair Positions
Canada Research Chair
Economic Evaluation and Technology Assessment in Child Health

Chair
Ontario Genetics Advisory Committee, Health Quality Ontario

Other Positions
Adjunct Scientist
Institute for Clinical Evaluative Sciences


Phone: 416-813-8519
Fax: 416-813-5979
Email: wendy.ungar@sickkids.ca

For more information, visit:

Paediatric Economic Database Evaluation
Technology Assessment at SickKids (TASK)

Brief Biography

Wendy Ungar is a Senior Scientist in Child Health Evaluative Sciences at The Hospital for Sick Children (SickKids) in Toronto, a Professor in Health Policy, Management and Evaluation at the University of Toronto, and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences. Dr. Ungar is a member of the Ontario Health Technology Advisory Committee (OHTAC) and chairs the Ontario Genetic Advisory Committee with a mandate to advise OHTAC on the clinical utility, validity, and value for money of new and existing genetic and genomic tests in Ontario. In 2010, Dr. Ungar’s book, Economic Evaluation in Child Health, was published by Oxford University Press.

Why do health care costs keep rising? How can we continue to afford it? Is all the new technology increasingly used in patient care actually making us healthier? With a focus on genomics, these are some of the questions that Dr. Ungar and her team address in her program of research investigating the application of health economic methods to the paediatric population.

Dr. Ungar also studies the relationship between policies governing access to prescription medicines and health outcomes in children. In 2007, Dr. Ungar started TASK (Technology Assessment at SickKids), a Health Technology Assessment (HTA) unit focusing on technology assessment of paediatric health interventions. Dr. Ungar and her research team created and maintain the PEDE database, a popular on-line health technology assessment tool for examining health economic evidence in children.

Research Interests

  • Defining and measuring value of emerging genetic testing technologies
  • Determining the use and cost-effectiveness of autism services across sectors
  • Paediatric economic evaluation methods research
  • Parent and child preferences and willingness to pay for costly paediatric technologies
  • Pharmaceutical policy and health outcomes in children

Research Activities

Sequencing technologies are poised to exert a profound impact on paediatric medicine, yet there is little research investigating their role, value for money, and patient and public preferences.

Current research is assessing the cost-effectiveness of sequencing in neurodevelopmental disorders such as autism and in cardiology where early identification of mutations may improve management and long-term outcomes. Additional research is aimed at exploring personal utility and public preferences for sequencing technologies. 

Evaluating the breadth of interventions used by children with autism of all ages, and assessing the cost-effectiveness of autism interventions is another area of active research as policy makers across Canada grapple with reforming autism programs to serve the needs of Canadian children and their families. Methodologic research to advance the tools and approaches available for child health technology assessment is integrated throughout the research.

The provision of medications is a major component of health care not universally covered by provincial health programs. Payment for medications can impose a significant financial burden on the families of children with acute or chronic diseases requiring medical treatment. A current avenue of research focuses on the health consequences in children of policies governing access to medications.

External Funding

  • Canadian Institutes for Health Research
  • Genome Canada
  • AllerGen Networks of Centres for Excellence
  • Ontario Ministry of Health and Long-Term Care Drug Innovation Fund
  • Ontario Lung Association
  • Organization of Teratology Information Services

Publications

Lamsal R,* Ungar WJ. Impact of growing up with a sibling with a neurodevelopmental disorder on the quality of life of an unaffected sibling: a scoping review. Disability and Rehabilitation, October 2018, https://doi.org/10.1080/09638288.2019.1615563    PA

Tsiplova K, Ungar WJ, Flanagan HE, den Otter J, Waddell C, Murray P, D’Entremont B, Garon N, Léger N, Bryson SE, Smith IM. Types of services and costs of programs for preschoolers with autism spectrum disorder across sectors: a comparison of two Canadian provinces. Journal of Autism and Developmental Disorders, 49(6): 2492-2508, 2019,  https://doi.org/10.1007/s10803-019-03993-3  SRA  

Goh E S-Y,* Miller FA, Marshall DA, Ungar WJ. Genetic counsellors’ preferences for coverage of preimplantation genetic diagnosis: a discrete choice experiment.  Clinical Genetics, 95(6): 684-692, 2019, https://doi.org/10.1111/cge.13531   SRA

Kwon J, Kim SW, Ungar WJ, Tsiplova K, Madan J, Petrou S. Patterns, trends and methodological associations in the measurement and valuation of childhood health utilities. Quality of Life Research, 2019, https://doi.org/10.1007/s11136-019-02121-z    CPA

Lavelle TA, D’Cruz B, Mohit B, Ungar WJ, Prosser LA, Neumann PJ, Tsiplova K, Vera-Llonch M, Lin P-J. Family spillover effects in pediatric cost-effectiveness analyses. Applied Health Economics and Health Policy, 17(2): 163-174, 2019, https://doi.org/10.1007/s40258-018-0436-0   PA

Mendlowitz A,* Widjaja E,* Phan C,* Sun Z,* Moretti ME, Schuh S, Coyte PC, Hancock-Howard R, Freedman S, Ungar WJ. A cost analysis of pulse oximetry as a determinant in the decision to admit infants with mild to moderate bronchiolitis. Pediatric Emergency Care, 2019, http://doi.org/10.1097/PEC.0000000000001664   SRA

Yuen T,* Carter MT, Szatmari P, Ungar WJ. Cost-effectiveness of universal or high-risk screening compared to surveillance monitoring in autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(9): 2968–2979, 2018, https://doi.org/10.1007/s10803-018-3571-4  SRA

Yuen T,* Penner M, Carter MT, Szatmari P, Ungar WJ. Cost-effectiveness of genome and exome sequencing in children diagnosed with autism spectrum disorder. Applied Health Economics & Health Policy, 16(4): 481-493, 2018, https://doi.org/10.1007/s40258-018-0390-x   SRA

Lin E, Durbin J, Guerriere D, Volpe T, Selick A, Kennedy J, Ungar WJ, Lero DS. Assessing care-giving demands, resources and costs of family/friend caregivers for persons with mental health disorders: a scoping review. Health & Social Care in the Community, 26(5):613–634, 2018, https://doi.org/10.1111/hsc.12546  CPA

Najafzadeh M, Ungar WJ, Hadioonzadeh A, Tsao N, Lynd LD. Comparing different experimental designs for best-worst scaling choice experiments: the case of asthma control. International Journal of Health Preference Research, 1:3-16, 2018, https://doi.org/10.21965/IJHPR.2018.001  SRA

Ungar WJ, Denburg A. An international perspective on ethical considerations in health economic evaluation: A primer for pediatric psychologists. Clinical Practice in Pediatric Psychology, 6(2): 190-200, 2018, http://doi.org/10.1037/cpp0000225  SRA

Ungar WJ, Tsiplova K, Millar N, Smith IM. Development of the Resource Use Questionnaire (RUQ-P) for families with preschool children with neurodevelopmental disorders: validation in children with autism spectrum disorder. Clinical Practice in Pediatric Psychology, 6(2): 164-178, 2018, https://doi.org/10.1037/cpp0000226  SRA

Moretti ME,* Lato DF, Berger H, Koren G, Ito S, Ungar WJ. A cost-effectiveness analysis of maternal CYP2D6 genetic testing to guide treatment for postpartum pain and avert infant adverse events. The Pharmacogenomics Journal, 18(3): 391-397, 2018, https://doi.org/10.1038/tpj.2017.33  SRA

Kwon J, Kim SW, Ungar WJ, Tsiplova K, Madan J, Petrou S. A systematic review and meta-analysis of childhood health utilities. Medical Decision Making, 38(3): 277-305, 2018, https://doi.org/10.1177/0272989X17732990 CPA

Penner M,* Anagnostou E, Ungar WJ. Practice patterns and determinants of wait time for autism spectrum disorder diagnosis in Canada. Molecular Autism, 9:16, 2018, https://doi.org/10.1186/s13229-018-0201-0 SRA

Dong Z,* Connolly BL, Ungar WJ, Coyte P. A cost analysis of peripherally inserted central catheter in paediatric patients. International Journal of Technology Assessment in Health Care, 34(1): 38-45, 2018, https://doi.org/10.1017/S026646231700109X  PA

Hayeems RZ, Bhawra J, Tsiplova K, Meyn MS, Monfared N, Bowdin S, Stavropoulos DJ, Marshall CR, Basran R, Shuman C, Ito S, Cohn I, Hum C, Girdea M, Brudno M, Cohn RD, Scherer SW, Ungar WJ. Care and cost consequences of pediatric whole genome sequencing compared to chromosome microarray.  European Journal of Human Genetics, 25(12): 1303-1312, 2017, http://dx.doi.org/10.1038/s41431-017-0020-3   PA

Denburg AE,* Ungar WJ, Greenberg M. Public drug policy for children in Canada, CMAJ, 189(30): E990-E994, 2017, http://dx.doi.org/10.1503/cmaj.170380   PA

Oei K, Hayeems R, Ungar WJ, Cohn RD, Cohen E. Genetic testing among children in a complex care program. Children, 4(5): 42, 2017, http://dx.doi.org/ 10.3390/children4050042  C

Tsiplova K, Zur RM, Marshall CR, Stavropoulos DJ, Pereira SL, Merico D, Young EJ, Sung WWL, Scherer SW, Ungar WJ. A microcosting and cost-consequence analysis of genomic testing strategies in autism spectrum disorder. Genetics in Medicine, 19(11): 1268-1275, 2017, http://dx.doi.org/10.1038/gim.2017.47 SRA

Ting EEK,* Sander B, Ungar WJ. Systematic review of the cost-effectiveness of influenza immunization programs. Vaccine, 35(15): 1828-1843, 2017, http://dx.doi.org/10.1016/j.vaccine.2017.02.044  SRA

Sullivan SM, Tsiplova K, Ungar WJ. A scoping review of pediatric economic evaluation 1980-2014: Do trends over time reflect changing priorities in evaluation methods and childhood disease? In press, Expert Review of Pharmacoeconomics and Outcomes Research, 2017. 

Ungar WJ. A further examination of the problem of double-counting in incremental cost-utility analysis. Expert Review of Pharmacoeconomics and Outcomes Research, 16(3): 333-335, 2016, doi: 10.1080/14737167.2016.1182865. 

Luca NJ, Burnett HF, Ungar WJ, Moretti ME, Beukelman T, Feldman BM, Schwartz G, Bayoumi AM. Cost-effectiveness analysis of early biologic treatment in polyarticular juvenile idiopathic arthritis. In press Arthritis Care and Research, ePub 5 April 2016, doi:  10.1002/acr.22903  

Roy L, Zur RM, Uleryk E, Carew C, Ito S, Ungar WJ. Thiopurine s-methyltransferase testing for averting drug toxicity in patients receiving thiopurines: A systematic review. Pharmacogenomics, 17(6): 633-56, 2016, doi: 10.2217/pgs.16.12. 

Bashir N, Ungar WJ. The 3-I Framework: A framework for developing public policies regarding pharmacogenomics (PGx) testing in Canada. Genome, 58(12): 527-540, 2015. doi 10.1139/gen-2015-0100 

Ungar WJ, Hadioonzadeh A, Najafzadeh M, Tsao NW, Dell S, Lynd LD. Parents and adolescents preferences for asthma control: A best-worst scaling choice experiment using an orthogonal main effects design. BMC Pulmonary Medicine, Nov 17;15:146. 2015, doi: 10.1186/s12890-015-0141-9. .

Ungar WJ. Next generation sequencing and health technology assessment in autism spectrum disorder. Canadian Journal of Child and Adolescent Psychiatry, 24(2): 123-127, 2015 (featured on journal cover).

Schuh S, Freedman S, Coates A, Allen U, Parkin P, Stephens D, Ungar W, Da Silva Z, Willan A. Impact of oximetry on hospitalization in bronchiolitis - a randomized trial. JAMA, 312(7):712-718, 2014, doi:10.1001/jama.2014.8637.

Burnett HF, Ungar WJ, Regier DA, Feldman BM, Miller FA. Parent willingness-to-pay for biologic treatments in juvenile idiopathic arthritis. Value in Health, 17(8):830-837, 2014.

Ungar WJ, Prosser LA, Burnett H. Values and evidence colliding: Health technology assessment in child health. Expert Review of Pharmacoeconomics and Outcomes Research, 13(4):417-419, 2013 (lead article).

Caulfield T, Evans J, McGuire A, McCabe C, Bubela T, Cook-Deegan R, Fishman J, Hogarth S, Miller FA, Raviskty V, Biesecker B, Borry P, Cho M, Carroll JC, Etchegary H, Joly Y, Kato K, Soo-Jin Lee S, Rothenberg K, Sankar P, Szego MJ, Ossorio P, Pullman D, Rousseau F, Ungar WJ, Wilson B. Reflections on the cost of “low-cost” whole genome sequencing: Framing the health policy debate. PLoS Biology 11(11): e1001699. doi:10.1371/journal.pbio.1001699, 2013

Ungar WJ, Costa V, Burnett H, Feldman BM, Laxer RM. The use of biologic response modifiers in polyarticular-course juvenile idiopathic arthritis: A systematic review. Seminars in Arthritis and Rheumatism, 42(6):597-618, 2013.

Gauvreau C, Ungar WJ, Köhler JC, Zlotkin S. The use of cost-effectiveness analysis for pediatric immunization in developing countries. The Milbank Quarterly, 90(4):762-790, 2012.

Hancock-Howard RL, Ungar WJ, Marshall D, Einarson A, Koren G. Public preferences for counseling regarding antidepressant use during pregnancy: A discrete choice experiment. Birth Defects Research Part A: Clinical and Molecular Teratology, Jul; 94(7):532-539, 2012.

Ungar WJ, Boydell K, Dell S, Feldman BM, Marshall D, Willan A, Wright J. A parent-child dyad approach to the assessment of health status and health-related quality of life in children with asthma. PharmacoEconomics, 30(8):697-712, 2012.

Burnett HF, Regier DA, Feldman BM, Miller FA, Ungar WJ. Parents’ preferences for drug treatments in juvenile idiopathic arthritis: A discrete choice experiment. Arthritis Care & Research, 64(9):1382-1391,

Kromm SK, Bethell J, Kraglund F, Edwards S, Laporte A, Coyte PC, Ungar WJ. Characteristics and quality of pediatric cost-utility analyses. Quality of Life Research, 21(8):1315-1325, 2012.

Ungar WJ. Medication cost-sharing and health outcomes in children with asthma. JAMA, March; 307(12):1316-1318, 2012.

Ungar WJ. Challenges in health state valuation in pediatric economic evaluation: Are QALYs contraindicated? PharmacoEconomics, 29(8):641-652, 2011

Ungar WJ, Paterson JM, Gomes T, Bikangaga P, Gold M, To T, Kozyrskyj AL. Relationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma. Annals of Allergy, Asthma & Immunology, 106:17–23, 2011.

Ungar WJ, Costa V, Hancock-Howard RL, Feldman B, Laxer RM. Cost-effectiveness of biologics in polyarticular-course juvenile idiopathic arthritis patients unresponsive to disease modifying anti-rheumatic drugs. Arthritis Care & Research, January; 63(1):111–119, 2011.