Abstract
The objective of this study was to compare Health-Related Quality of Life (HRQoL) as measured by the 16D instrument with four condition-specific instruments in children and adolescents with significant post-traumatic stress disease (PTSD), to assess the validity of the 16D instrument. In addition, we test for differences in health for the PTSD population compared to a representative sample of Finnish schoolchildren. The study included 156 children and adolescents with trauma-related symptoms in Norway. The condition-specific instruments included were; Child PTDS Symptom Scale (CPSS); Mood and Feelings Questionnaire (MFQ); Screen for Child Anxiety Related Emotional Disorders (SCARED), and; Strengths and Difficulties Questionnaire (SDQ). We found that the 16D HRQoL score was significantly correlated with all condition-specific instruments (CPSS, SCARED, MFQ, and SDQ), where SCARED had the highest correlation with the 16D (-0.659, p < 0.01). Several of the corresponding items (sleep, distress, discomfort and symptoms, mental functioning, and school and hobbies) of the condition-specific instruments were correlated above the threshold (convergent validity, ρ > 0.4). Children and adolescents with symptoms of post-traumatic stress experienced a significant health loss of 0.177 compared to a representative sample of Finnish 12 to 15-years-old schoolchildren with a Cohen’s d of 1.07, and the health difference was significant for all 16 dimensions. These findings support the use of the 16D to measure health outcomes in cost-utility analysis. More studies are needed to examine the responsiveness.
 Published: Online August 2020.
Highlights
In several countries, cost-effectiveness analysis (CEA) is the recommended method to guide reimbursement decisions (CADTH, 2017; Guidelines NOMA, 2018; Guidelines Dutch, 2016)
The range of responses covered the range of severity levels in all condition-specific instrument, except for Child PTSD Symptom Scale (CPSS), where the inclusion criteria for the trial was defined at CPSS equal or greater than 15
Our results revealed that overall health related quality of life (HRQoL) scores of the 16D correlate well with the condition-specific scores relevant to the population of children and adolescent with post-traumatic stress disease (PTSD) being studied
Summary
Cost-effectiveness analysis (CEA) is the recommended method to guide reimbursement decisions (CADTH, 2017; Guidelines NOMA, 2018; Guidelines Dutch, 2016). In the CEA guidelines, the health outcome should be measured by a generic instrument, while the resource use could either adapt a health care- or a societal perspective. The health outcome is measured in quality adjusted life years (QALYs), combining health related quality of life (HRQoL) and time. HRQoL is usually computed with a multi-attribute instrument (16D, EQ-5D, or SF-6D, Drummond et al, 2015), including items that represent dimensions of health (e.g., depression, mobility, pain, etc.), and level of severity (e.g., not a problem, moderate problem, and severe problem). Each health state (combination of items and severity) is scored between 0 and 1, where 0 refers to death and 1 to perfect health (Drummond et al, 2015), and where one QALY is defined as being in perfect health for one year. Weights are elicited from valuation studies in the general population
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