Abstract
ObjectivesDiscrete choice experiments (DCEs) can be used to obtain latent scale values for the EQ-5D-Y, but these require anchoring at 0 = dead to meet the conventions of quality-adjusted life year (QALY) estimation. The primary aim of this study is to compare four preference elicitation methods for obtaining anchors for latent scale EQ-5D-Y values.MethodsFour methods were tested: visual analogue scale (VAS), DCE (with a duration attribute), lag-time time trade-off (TTO) and the location-of-dead (LOD) approach. In computer-assisted personal interviews, UK general public respondents valued EQ-5D-3L health states from an adult perspective and EQ-5D-Y health states from a 10-year-old child perspective. Respondents completed valuation tasks using all four methods, under both perspectives.Results349 interviews were conducted. Overall, respondents gave lower values under the adult perspective compared to the child perspective, with some variation across methods. The mean TTO value for the worst health state (33333) was about equal to dead in the child perspective and worse than dead in the adult perspective. The mean VAS rescaled value for 33333 was also higher in the child perspective. The DCE produced positive child perspective values and negative adult perspective values, though the models were not consistent. The LOD median rescaled value for 33333 was negative under both perspectives and higher in the child perspective.DiscussionThere was broad agreement across methods. Potential criteria for selecting a preferred anchoring method are presented. We conclude by discussing the decision-making circumstances under which utilities and QALY estimates for children and adults need to be commensurate to achieve allocative efficiency.
Highlights
The EQ-5D-Y (Youth; three-level version1) has been developed as a measure of health outcomes suitable for children and adolescents [1, 2]
Two methodological EQ-5D-Y valuation studies undertaken to date—one using visual analogue scale (VAS) [3] and the other using composite time trade-off (C-TTO) and a discrete choice experiment (DCE) with death [4]—have
Both studies reported differences in values elicited under adult health and child health perspectives, but in different directions: Kind et al reported lower mean VAS ratings for the child perspective compared to the adult perspective, while Kreimeier et al reported higher mean TTO values for the child perspective
Summary
The EQ-5D-Y (Youth; three-level version1) has been developed as a measure of health outcomes suitable for children and adolescents [1, 2]. The higher TTO values for the child perspective might have been driven by respondents’ aversion or unwillingness to trade off life years for a child (i.e. to choose to effectively shorten a child’s life). Both of the valuation techniques used by Kreimeier et al included direct comparisons of health states with (immediate) death, whereas the VAS approach used by Kind et al did not include any attempt to compare with or anchor at dead. The Kind et al study did not include health state 33333 in its design
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