Wendy Ungar, PhD
Child Health Evaluative Sciences
University of Toronto
Health Policy, Management and Evaluation
Institute for Clinical Evaluative Sciences
Wendy Ungar M.Sc., PhD is a Senior Scientist in Child Health Evaluative Sciences at The Hospital for Sick Children, Toronto, Canada, an Associate Professor in Health Policy, Management and Evaluation, University of Toronto, and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences. Dr. Ungar is the University of Toronto Program Director for the International Masters in Health Technology Assessment & Management (Ulysses program) and has held a Canadian Institutes of Health Research New Investigator career award.
Why do health care costs keep rising? How can we continue to afford it? Is all this new technology in health care actually making us healthier? 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.
- Paediatric economic evaluation methods research
- Pharmaceutical policy and health outcomes in children with asthma
- Economic burden of chronic paediatric conditions
- Cost-effectiveness of interventions and programs for children
- Parent and child preferences for treatment attributes
Measurement of quality of life and preferences for health states (utility) poses a number of challenges in children. Current research is examining novel approaches to utility and quality of life assessment for incorporation in cost-utility analysis and clinical research.
Through detailed health technology assessments, additional research is exploring the cost-effectiveness of treatments in maternal and child health, including biologics for juvenile idiopathic arthritis, genotyping to guide therapy in children with acute lymphoblastic leukemia, CYP2D6 testing to guide postnatal pain management in lactating women and teratogen counseling in pregnant women requiring anti-depressants. These evaluations can be used for informing health policy and allocation decision-making.
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 with asthma of policies governing access to medications.
Future Research Interests
Future research will study the use of stated preference techniques, including discrete choice experiments, to evaluate parent, child and family preferences with regard to treatment choice, health states and willingness-to-pay. Understanding the inter-dependent relationship among family members with regard to quality-of-life and the use of and payment for health care services is critical for designing health care policies that are responsive to the needs of children and families. Additional studies will compare the stated preferences of families to asthma health care providers to improve the design of clinical practice guidelines and asthma education programs.
- Canadian Institutes for Health Research
- Ontario Ministry of Health and Long-Term Care Drug Innovation Fund
- Genome Canada
- AllerGen Networks of Centres for Excellence
- Ontario Lung Association
- Organization of Teratology Information Services
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, Hadioonzadeh A, Najafzadeh M, Tsao NW, Dell S, Lynd LD. Preferences for asthma control in parents and adolescents using a best-worst scaling experiment. Respiratory Medicine 108:842-851, 2014, dx.doi.org/10.1016/j.rmed.2014.03.014
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
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
Tsimicalis A, Stevens B, Ungar WJ, McKeever P, Greenberg M, Agha M, Guerriere D, Naqvi A, Barr R. A mixed method approach to describe the out-of-pocket expenses incurred by families of children with cancer. Pediatric Blood and Cancer, 60(3):438-445, 2013
Gauvreau C, Ungar WJ, KÃ¶hler JC, Zlotkin S. The use of cost-effectiveness analysis for pediatric immunization in developing countries. The Milbank Quarterly, 90(4):762-790, 2012.
Ungar WJ. Understanding the value of information from pediatric clinical research. Pediatric Drugs, August 14(5):295-297, 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. Parentsâ€™ preferences for drug treatments in juvenile idiopathic arthritis: A discrete choice experiment. Arthritis Care & Research, 64(9):1382-1391, 2012
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
Donnan JR, Ungar WJ, Mathews M, Rahman P. Systematic review of thiopurine methyltransferase genotype and enzymatic testing strategies. Therapeutic Drug Monitoring, 33:192–199, 2011
Donnan JR, Ungar WJ, Mathews M, Hancock-Howard RL, Rahman P. A cost effectiveness analysis of thiopurine methyltransferase testing for guiding 6-mercaptopurine dosing in children with acute lymphoblastic leukemia. Pediatric Blood & Cancer, 57:231-239, 2011
Ungar WJ, Paterson M, Gomes T, Bikangaga P, Gold M, To T, Kozyrskyj A. Effects of asthma management, socioeconomic status and insurance characteristics on exacerbations in children with asthma. Annals of Allergy, Asthma & Immunology, 106:17–23, 2011
Goeree R, Hopkins R, Marshall JK, Armstrong D, Ungar WJ, Goldsmith C, Allen C, Anvari M. Cost-utility of Laparoscopic Nissen Fundoplication versus proton pump inhibitors for gastro-esophageal reflux disease: A 3-year prospective randomized controlled trial and economic evaluation. Value in Health, 14:263-273, 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
Tsimicalis A, Stevens B, Ungar WJ, McKeever P, Greenberg M. The cost of childhood cancer from the family’s perspective: A critical review. Pediatric Blood & Cancer, 56:707-717, 2011
Woo G, Tomlinson G, Nishikawa Y, Kowgier M, Sherman M, Wong DKH, Pham B, Ungar WJ, Einarson T, Heathcote EJ, Krahn M. Tenofovir and Entecavir are the most effective antiviral agents for chronic hepatitis B: A systematic review and Bayesian meta-analyses. Gastroenterology, Oct;139(4):1218-29, 2010
Ungar WJ, Gerber A. The uniqueness of child health and challenges to measuring costs and consequences, in Ungar WJ (ed) Economic Evaluation in Child Health. Oxford: Oxford University Press, 2010
Hancock RL, Ungar WJ, Einarson A, Koren G. International practices in the provision of teratology information: A survey of international teratogen information programs and comparisons with the North American model. Journal of Evaluation in Clinical Practice 16(5):957-963, 2010
Ungar WJ (Editor). Economic Evaluation in Child Health. Oxford: Oxford University Press, 2010.
Hancock-Howard RL, McMahon M, Menon-Nair A, Woo G, Aziza A, Laporte A, Nauenberg E, Connolly BL, Wales PW, Ungar WJ. A cost effectiveness analysis of port insertion using image guided therapy versus conventional operating room methods. Journal of Vascular and Interventional Radiology, May;21(5):677-84, 2010
Ungar WJ, Cope SF, Kozyrskyj A, Paterson JM. Socioeconomic factors and home allergen exposure in children with asthma. Journal of Pediatric Health Care 24(2):108-115, 2010
Yong JHE, Schuh S, Rashidi R, Vanderby S, Lau R, Laporte A, Nauenberg E, Ungar WJ. A cost-effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis. Pediatric Pulmonology 44(2):122-127, 2009
Cope SF, Ungar WJ, Glazier RH. International differences in asthma guidelines for children. International Archives of Allergy and Immunology 148(4):265-278, 2009
Wan M, Doria A, Krahn M, Ungar WJ, Medina S, Sung L. Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis--a Markov decision analytic model. Radiology, 250(2): 378-86, 2009
Sharieff W, Zlotkin S, Ungar WJ, Feldman BM, Krahn M, Tomlinson G. The economics of preventing premature mortality and impaired cognitive development in children through home-fortification: a health policy perspective. International Journal of Technology Assessment and Health Care 24(3):303-311, 2008
Cope SF, Ungar WJ, Glazier RH. Socioeconomic factors and asthma control in children. Pediatric Pulmonology 43(8):745-752, 2008
Ungar WJ, Paterson M, Cope S, Kozyrskyj A. Improving drug benefits for children with asthma: building a research agenda. Healthcare Policy 3(4):66-76, 2008
Guerriere DN, Tranmer JE, Ungar WJ, Manoharan V, Coyte PC. Valuing care recipient and family caregiver time: a comparison of methods. International Journal of Technology Assessment in Health Care, 24(1):52-59, January 2008
Ungar WJ, Kozyrskyj A, Paterson M, Ahmad F. Impact of cost-sharing on asthma medication use in children. Archives of Pediatrics & Adolescent Medicine 2008; 162(2):104-110
Han RK, Ungar WJ, Macarthur C. Cost effectiveness analysis of a proposed public health legislative/educational strategy to reduce tap water scald injuries in children. Injury Prevention 2007; 13: 248-253
Ungar WJ, Davidson-Grimwood SR, Cousins M. Parents were accurate proxy reporters of urgent pediatric asthma health services – a retrospective agreement analysis. Journal of Clinical Epidemiology 2007; 60(11):1176-1183
Ungar WJ. Paediatric health economic evaluations: a world view. Healthcare Quarterly 2006; 10(1): 134-140
Ungar WJ, Mirabelli C, Cousins M, Boydell KM. A qualitative analysis of a dyad approach to quality of life measurement in children with asthma. Social Science & Medicine 2006; 63(9):2354-66
Kozyrskyj AL, Dahl ME, Ungar WJ, Becker AB, Law BJ. Antibiotic treatment of wheezing in children with asthma: what is the practice? Pediatrics 2006; 117(6):e1104-10
Motiwala S, Gupta S, Lilly M, Ungar WJ, Coyte PC. The cost-effectiveness of expanding intensive behavioural intervention (IBI) to all autistic children in Ontario. Healthcare Policy 2006; 1(2):135-151
Ungar WJ, Witkos M. Public drug plan coverage for children across Canada: a portrait of too many colours. Healthcare Policy 2005; 1(1):100-122
Ungar WJ, Santos MT. The quality of pediatric health economic evaluations. International Journal of Technology Assessment and Health Care 2005; 21(2):203-210
Ungar WJ, Ariely R. Health insurance, access to prescription medicines and health outcomes in children. Expert Review of Pharmacoeconomics & Outcomes Research 2005; 5(2):215-225
Economic Evaluation in Child Health, Edited by Wendy Ungar. Publication Date: November 2009