Using Age-Specific Values for Pediatric HRQoL in a Cost-Effectiveness Analysis: Is There a Problem to Be Solved? If So, How?

Nancy J. Devlin*, Tianxin Pan, Mark Sculpher, Mark Jit, Elly Stolk, Donna Rowen, Barend van Hout, Richard Norman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
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Value sets for the EQ-5D-Y-3L published to date appear to have distinctive characteristics compared with value sets for corresponding adult instruments: in many cases, the value for the worst health state is higher and there are fewer values < 0. The aim of this paper is to consider how and why values for child and adult health differ; and what the implications of that are for the use of EQ-5D-Y-3L values in economic evaluations to inform healthcare resource allocation decisions. We posit four potential explanations for the differences in values: (a) The wording of severity labels may mean the worst problems on the EQ-5D-Y-3L are descriptively less severe than those on the EQ-5D-5L; (b) Adults may genuinely consider that children are less badly affected than adults by descriptively similar health issues. That is, for any given health problem, adult respondents in valuation studies consider children’s overall health-related quality of life (HRQoL) on average to be higher than that for adults; (c) Values are being sought by eliciting adults’ stated preferences for HRQoL in another person, rather than in themselves (regardless of whether the ‘other person’ concerned is a child); and (d) The need to elicit preferences for child HRQoL that are anchored at dead = 0 invokes special considerations regarding children’s survival. Existing evidence does not rule out the possibility that (c) and (d) exert an upward bias in values. We consider the implications of that for the interpretation and use of values for pediatric HRQoL. Alternative methods for valuing children’s HRQoL in a manner that is not ‘age specific’ are possible and may help to avoid issues of non-comparability. Use of these methods would place the onus on health technology assessment bodies to reflect any special considerations regarding child quality-adjusted life-year gains.

Original languageEnglish
Pages (from-to)1165-1174
Number of pages10
Issue number10
Early online date13 Jul 2023
Publication statusPublished - Oct 2023

Bibliographical note

Funding Information:
Work on this paper was supported by EuroQol Research Foundation Grant 202-2020RA. Opinions expressed in the paper are not necessarily those of the EuroQol Group or of the Younger Populations Working Group. Mark Jit was also supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Modelling and Health Economics (NIHR200908) and in Immunisation (NIHR200929).

Publisher Copyright:
© 2023, The Author(s).


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