An Assessment of the Validity and Reliability of the Pediatric Child Health Utility 9D in Children with Inflammatory Bowel Disease.

Naazish S Bashir,Thomas D Walters,Wendy J Ungar,Anne M Griffiths

doi:10.3390/children8050343

Abstract

Health utilities relevant to children are lacking, compromising health funding and policy decisions for children. The Child Health Utility 9D (CHU9D) is a recently developed preference-based health utility instrument designed for use in children. The objective was to examine the validity of the CHU9D in a cohort of 285 Canadian children aged 6.5 to 18 years of age with Crohn’s disease (CD) and ulcerative colitis (UC), (collectively inflammatory bowel disease (IBD)). The correlation and agreement between paired CHU9D and Health Utility Index (HUI) assessments were determined with Spearman coefficients and Bland–Altman levels of agreement. Total and domain utilities were calculated for the CHU9D using Australian adult and youth tariffs. Algorithms for HUI2 and HUI3 were used. Domain correlations were determined between domains with expected overlap between instruments. In CD and in UC, correlations between CHU9D, HUI2, and HUI3 utilities ranged between 0.62 to 0.67 and 0.67 to 0.69, respectively (p < 0.05). CHU9D utilities were lower using youth tariffs compared to adult tariffs. A large range in health utilities suggested a heterogeneous quality of life. The CHU9D is a good option for preference-based utility measurement in pediatric IBD. Additional research is required to derive pediatric tariffs to conduct economic evaluation in children.

Highlights

Economic evaluations, such as cost–utility analyses, are increasingly used as part of the health technology assessment of new interventions for public or private payer reimbursement across the globe
In the Crohn’s disease (CD) group, 59.8% of participants were of Caucasian origin and in the ulcerative colitis (UC) group, 65.1% of participants were of Caucasian origin, with the rest from diverse backgrounds
Considering the overall correlations, and agreement at high utility scores most often observed in Inflammatory bowel disease (IBD), the Child Health Utility 9D (CHU9D) showed good construct validity with the HIU2 and HUI Mark 3 (HUI3) in a CD and UC population of children aged 7 to 18 years

Summary

Introduction

Economic evaluations, such as cost–utility analyses, are increasingly used as part of the health technology assessment of new interventions for public or private payer reimbursement across the globe. Quality-adjusted life years (QALYs), an output of economic evaluation, are a measure weighting the length of life by health-related quality-of-life, expressed as health utilities. Generic health instruments are questionnaires that comprise both a classification system and a valuation algorithm based on multi-attribute utility theory [1]. The classification system describes domains of health-related quality of life according to severity levels. Preference-based generic health utility instruments allow for a comparison of health-related quality of life across diverse patient populations. These instruments have been developed and validated in adult populations but have been understudied in children [2,3]

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