Valuing Child Health Utility 9D Health States with a Young Adolescent Sample

Abstract

QALYs are increasingly being utilized as a health outcome measure to calculate the benefits of new treatments and interventions within cost-utility analyses for economic evaluation. Cost-utility analyses of adolescent-specific treatment programmes are scant in comparison with those reported upon for adults and tend to incorporate the views of clinicians or adults as the main source of preferences. However, it is not clear that the views of adults are in accordance with those of adolescents on this issue. Hence, the treatments and interventions most highly valued by adults may not correspond with those most highly valued by adolescents. Ordinal methods for health state valuation may be more easily understood and interpreted by young adolescent samples than conventional approaches. The availability of young adolescent-specific health state values for the estimation of QALYs will provide new insights into the types of treatment programmes and health services that are most highly valued by young adolescents. The first objective of this study was to assess the feasibility of applying best-worst scaling (BWS) discrete-choice experiment (DCE) methods in a young adolescent sample to value health states defined by the Child Health Utility 9D (CHU9D) instrument, a new generic preference-based measure of health-related quality of life developed specifically for application in young people. The second objective was to compare BWS DCE questions (where respondents are asked to indicate the best and worst attribute for each of a number of health states, presented one at a time) with conventional time trade-off (TTO) and standard gamble (SG) questions in terms of ease of understanding and completeness. A feasibility study sample of consenting young adolescent school children (n = 16) aged 11-13 years participated in a face-to-face interview in which they were asked to indicate the best and worst attribute levels from a series of health states defined by the CHU9D, presented one at a time. Participants were also randomly allocated to receive additional conventional TTO or SG questions and prompted to indicate how difficult they found them to complete. The results indicate that participants were able to readily choose 'best' and 'worst' dimension levels in each of the CHU9D health states presented to them and provide justification for their choices. Furthermore, when presented with TTO or SG questions and prompted to make comparisons, participants found the BWS DCE task easier to understand and complete. The results of this feasibility study suggest that BWS DCE methods are potentially more readily understood and interpretable by vulnerable populations (e.g. young adolescents). These findings lend support to the potential application of BWS DCE methods to undertake large-scale health state valuation studies directly with young adolescent population samples.

Valuing the Child Health Utility 9D: Using profile case best worst scaling methods to develop a new adolescent specific scoring algorithm

“…Since these estimates were on an interval scale, re-scaling via an external cardinal valuation task using traditional health state valuation methods, e.g., the TTO or SG, was necessary to ensure that 0 represented the death state. Whilst it would be ideal to conduct the re-scaling using data generated from an adolescent sample, our previous research has highlighted the ethical difficulties associated with this process (Ratcliffe et al, 2011). In addition we found a poor level of understanding of TTO and SG methods in general in adolescents (Ratcliffe et al, 2011).…”

“…Whilst it would be ideal to conduct the re-scaling using data generated from an adolescent sample, our previous research has highlighted the ethical difficulties associated with this process (Ratcliffe et al, 2011). In addition we found a poor level of understanding of TTO and SG methods in general in adolescents (Ratcliffe et al, 2011). Hence, for the purposes of this study we utilised the mean health state values derived from a conventional TTO task for a selection of CHU9D health states from a sample of young adults (aged 18 to 29 years) to re-scale the ordinal values derived from the BWS DCE task onto the 0 = death to 1 = full health QALY scale (Ratcliffe et al, 2015a).…”

“…Traditional DCE involves presenting the respondent with a number of choice scenarios in which they are required to indicate their preferences between two or more health states with varying survival durations whereas profile case BWS presents the respondent with a number of choice scenarios represented by one health state only and the respondent is asked to indicate the best and worst attribute of the health state under consideration (Flynn et al 2008). Previous research by Ratcliffe and colleagues found higher face validity and reliability for BWS methods relative to TTO and SG approaches in young people for the estimation of health state values for the CHU9D instrument (Ratcliffe et al, 2011). However it is important to note as highlighted previously that, of these approaches, only the SG includes a preference for risk and thereby satisfies the von Neumann-Morgenstern axioms of expected utility theory (Mehrez and Gafni 1993).…”

Preparatory study for the revaluation of the EQ-5D tariff: methodology report

“…Research comparing DCE and TTO has found that both techniques have equivalent levels of respondent comprehension and completion. 62 However, this study did not test the DCE TTO method, which may be more difficult than standard DCE owing to the addition of an attribute for duration.…”

“…However, earlier work comparing DCE and TTO found that both techniques could be understood equally well and had high completion rates. 62 On the other hand, the very factor that makes iterative tasks easier may introduce bias of its own. There is a literature on contingent valuation and willingness to pay in health economics, where it has been shown that iterative tasks may be susceptible to biases because respondents do not interpret the series of binary choices as independent.…”