OBJECTIVES: Across the globe, health inequalities exist between genders. One facet of gender health inequality is unpaid caregiving. Female carers account for 57%, 59%, and 65% of unpaid carers in France, England and Germany, leading to a disproportionate increase in negative health and economic consequences impacting women. The aim of this review was to examine the inclusion of carer burden in health technology assessments (HTA) in paediatric diseases across three HTA agencies to determine whether the HTA approach for inclusion of carer burden could impact gender health inequality.

METHODS: A targeted review of NICE technology appraisals (TA) (including highly specialised technology appraisals) for paediatric conditions including juvenile arthritis, chronic hepatitis-c, plaque psoriasis, and paediatric-onset hypophosphatasia was undertaken to identify interventions. These interventions were cross-referenced to appraisals published by IQWIG and HAS. Appraisal documents were then searched for ‘carer’ ‘caregiver’ ‘family’ ‘relative’.

RESULTS: Eight assessments were retrieved from the initial NICE search. Of these, all had a published assessment by HAS, and 3/8 assessments were assessed by IQWIG. Carer burden was included in 62.5% of the NICE assessments. No consideration of carer burden was included in HAS or IQWIG assessments.

CONCLUSIONS: Caregivers of ill children, especially female caregivers, face significant difficulties with physical, emotional, and economic consequences of caregiving. HTA in Germany demonstrates the most scope for improvement, with the largest proportion of female carers, and the least stringent guidelines regarding inclusion of carer burden. HTA in France also demonstrated that, despite carer burden inclusion in submission guidelines, there is a lack of carer burden evidence in published paediatric disease assessments. Although NICE demonstrates the most robust and frequent assessment of carer burden, continuing research is required to develop guidelines to accurately assess carer burden with the goal of improving carer outcomes and reducing gender health inequality exerted in unpaid care.