Abstract
ObjectiveThis study aimed to conduct a systematic review and meta-analysis to compare differences in health utilities (HUs) assessed by self and proxy respondents in children, as well as to evaluate the effects of health conditions, valuation methods, and proxy types on the differences.MethodsEligible studies published in PubMed, Embase, Web of Science, and Cochrane Library up to December 2019 were identified according to PRISMA guidelines. Meta-analyses were performed to calculate the weighted mean differences (WMDs) in HUs between proxy- versus self-reports. Mixed-effects meta-regressions were applied to explore differences in WMDs among each health condition, valuation method and proxy type.ResultsA total of 30 studies were finally included, comprising 211 pairs of HUs assessed by 15,294 children and 16,103 proxies. This study identified 34 health conditions, 10 valuation methods, and 3 proxy types. In general, proxy-reported HUs were significantly different from those assessed by children themselves, while the direction and magnitude of these differences were inconsistent regarding health conditions, valuation methods, and proxy types. Meta-regression demonstrated that WMDs were significantly different in patients with ear diseases relative to the general population; in those measured by EQ-5D, Health utility index 2 (HUI2), and Pediatric asthma health outcome measure relative to Visual analogue scale method; while were not significantly different in individuals adopting clinician-proxy and caregiver-proxy relative to parent-proxy.ConclusionDivergence existed in HUs between self and proxy-reports. Our findings highlight the importance of selecting appropriate self and/or proxy-reported HUs in health-related quality of life measurement and economic evaluations.
Highlights
Economic evaluation is used to compare the costs and consequences of alternative healthcare interventions
In order to avoid the large impact that a negative value has on the average health utilities (HUs) calculation, it is usually converted to a value between − 1 and 0, which is symmetrical to the value range for health conditions better than death [1]
Parents reported lower HUs in patients diagnosed with paediatric mobility impairment (WMD: − 0.058; 95% confidence intervals (CI) − 0.087, − 0.028), Main findings According to the results from weighted mean differences (WMDs) of different health conditions, we found that for mild health conditions such as the general population, overweight or obese, and Extremely low birth weight/extremely preterm (ELBW/EP), proxies tended to report higher HUs than children themselves; proxies tended to report lower HUs for severe diseases such as meningitis, pediatric mobility impairment, asthma, lung disease, spina bifida, injury, and chronic illness
Summary
Economic evaluation is used to compare the costs and consequences of alternative healthcare interventions. The measurements of various costs are similar; but the forms of health outcomes vary by different evaluation. When estimating HUs associated with different health states, both direct and indirect valuation methods can be used [5]. Direct methods indicate that the assessment and measurement process can be completed in one step. Indirect methods rely on the multi-attribute utility instruments (MAUIs) which comprise two main elements: a descriptive system for measuring health states and a scoring algorithm for valuing the health states defined by the descriptive system [6]. Used indirect methods for children include the Health Utilities Index (HUI) [7], the EuroQol 5-dimension (EQ-5D) Youth version (EQ-5D-Y) [8], and the Child Health Utility 9-Dimension (CHU9D) [9]
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