Abstract
ObjectivesThe recently published EQ-5D-Y valuation protocol prescribes the general public values EQ-5D-Y health states for a 10-year-old child. This child perspective differs from the individual perspective applied for valuation of adult EQ-5D instruments. This article discusses the rationale for and implications of applying a child perspective for EQ-5D-Y health state valuation. MethodsThis article was informed by an exploration of the normative and empirical literature on health state valuation. We identified and summarized key discussion points in a narrative review. ResultsAlthough valuing EQ-5D-Y health states from an individual perspective is feasible, it may be problematic for several reasons. The use of a child perspective implies that—rather than valuing one’s own health—someone else’s health is valued. This may require the projection of one’s own beliefs, expectations, and preferences on others, which could change the decision processes underlying the elicited preferences. Furthermore, because preferences are obtained for a 10-year-old child, it is unclear if this given age as well as other (missing) information on the described child beneficiary (should) affect valuation of EQ-5D-Y health states. ConclusionsThe change from an individual to a child perspective in the valuation of EQ-5D-Y will likely lead to differences in utilities. This has implications for the estimation of incremental health-related quality-of-life gains in economic evaluations of health technologies for children and adolescents and therefore might affect reimbursement decisions. Further research is necessary for gaining insight into the extent to which this impact is normatively and empirically justified.
Highlights
Economic evaluations of new health technologies are increasingly used in child and adolescent patient populations.[1]
Treatment-related health gains are often expressed in quality-adjusted life-years (QALYs), as this facilitates the comparison of health gains across health technologies and patient populations.[2]
QALYs are calculated by multiplying gains in life expectancy by a weight that represents the utility or value associated with the health-related quality of life (HRQOL) experienced during that time
Summary
Economic evaluations of new health technologies are increasingly used in child and adolescent patient populations.[1]. The utilities associated with each of these health states can be based on preferences that are elicited directly from persons who experience or experienced living in these health states, such as patients.[8,9,10] utilities can be based on preferences that are elicited indirectly from persons who (may) lack that experience The latter approach is referred to as indirect, because the EQ-5D is used to assess patients’ HRQOL, while the utility associated with the (possible change in their) health state is not based on their own preferences, but rather on preferences of a sample of adult members of the general public. This is referred to as the individual perspective
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