Assessing well-being in younger populations in economic evaluations: a scoping review of multidimensional instruments

Background: To comprehensively evaluate health care interventions in younger populations, outcome measurement in economic evaluation may need to be expanded beyond health-related quality of life to include well-being. However, whether appropriate well-being instruments exist for children remains uncertain. This study provides a systematic overview of multidimensional well-being instruments for children and assesses their potential applicability for economic evaluation. Methods: This scoping review was reported following the PRISMA-ScR guidelines. The search strategy included terms related to "well-being," "child or adolescent," and "instrument", and was implemented in four electronic databases, yielding a total of 9622 articles. Two reviewers independently screened articles with ASReview, a machine-learning-based tool for expediting screening, and manually extracted information from relevant articles. Findings were synthesized narratively, highlighting consistency and discrepancies, as well as potential suitability for economic evaluation (using multiple criteria). Results: Twentyfive studies were included, published between 1993 and 2024. On average, instruments assessed well-being with five dimensions and 38 questions. Common dimensions included physical, health, school, satisfaction, relationship(s), emotional and self. Dimensions that capture children’s daily experiences, such as family, achievement, education and after-school activities were frequently considered. Conclusion: The review highlights the variety of well-being instruments for children. Although many instruments measure well-being comprehensively, only ICECAP-CYP fit all criteria for suitability for economic evaluation. The small number of potentially suitable instruments highlights a growing yet still insufficient interest in moving beyond traditional HRQoL assessments in younger populations.