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Xiong X, Carvalho N, Huang L, Chen G, Jones R, Devlin N, Mulhern B, Dalziel K. Psychometric Properties of Child Health Utility 9D (CHU9D) Proxy Version Administered to Parents and Caregivers of Children Aged 2-4 Years Compared with Pediatric Quality of Life Inventory™ (PedsQL). PHARMACOECONOMICS 2024; 42:147-161. [PMID: 38280126 PMCID: PMC11169045 DOI: 10.1007/s40273-024-01355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE This study examines the psychometric properties of the Child Health Utility 9D (CHU9D) proxy version administered to parents/caregivers of 2-4-year-old Australian children compared with Pediatric Quality of Life Inventory™ version 4.0 (PedsQL). METHODS Data collected in 2021/2022 from parents/caregivers of 2-4-year-olds from the Australian pediatric multi-instrument comparison study were used. Feasibility, ceiling/floor effects, test-retest reliability, convergent validity, known-group validity, and responsiveness were assessed. RESULTS A total of 842 caregivers completed the survey at baseline, with 513 completing the follow-up survey. The CHU9D did not demonstrate ceiling effects in the sample with special health care needs, with only 6% of respondents reporting best levels for all nine dimensions. CHU9D correlated with PedsQL moderately-to-strongly between comparable items (correlation coefficients 0.34-0.70). CHU9D was able to differentiate between groups with known health differences with moderate-to-large effect sizes (Cohen's d 0.58-2.03). Moderate test-retest reliability was found for CHU9D in those reporting no health change at a 2-day follow-up (ICC 0.52). A standard response mean (SRM) of 0.25-0.44 was found for children with changes in general health and a SRM of 0.72-0.82 for children who reported worsened health when developing new illnesses, indicating small-to-large responsiveness according to different definitions of health changes. Compared with PedsQL, CHU9D had similar known-group validity and responsiveness and slightly poorer test-retest reliability. CONCLUSION The CHU9D was found to be valid and reliable to measure health-related quality-of-life in children aged 2-4 years, although with relatively low test-retest reliability in some dimensions. Further development and validation work is warranted.
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Affiliation(s)
- Xiuqin Xiong
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Natalie Carvalho
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Li Huang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Renee Jones
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Nancy Devlin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
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Khanna D, Khadka J, Mpundu-Kaambwa C, Chen G, Dalziel K, Devlin N, Ratcliffe J. An Investigation of Inter-Rater and Intra-Proxy Agreement in Measuring Quality of Life of Children in the Community Using the EQ-5D-Y-3L. PHARMACOECONOMICS 2024; 42:113-128. [PMID: 38280125 PMCID: PMC11169018 DOI: 10.1007/s40273-024-01356-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Self-reporting of health-related quality of life (HRQoL) in children is not always feasible. To date, proxy perspectives (Proxy versions 1 and 2) using the EQ-5D-Y-3L have not been explored for its impact on agreement with child self-report. Proxy version 1 requires the proxy to consider their own view of the child's HRQoL (proxy-proxy), while with Proxy version 2, the proxy is asked to respond as they believe their child would self-report their HRQoL (proxy-child). This study compared the inter-rater and intra-proxy agreement (overall and dimension level) using the EQ-5D-Y-3L self, proxy-proxy, and proxy-child reports. METHODS A community-based sample of child (aged 6-12 years) and parent dyads were invited to participate in a semi-structured interview. The child self-completed the EQ-5D-Y-3L independently of the parent who completed the EQ-5D-Y-3L from proxy-proxy and proxy-child perspectives. Agreement was determined using Concordance Correlation Coefficients (CCCs) for the overall (preference-weighted) HRQoL, while agreement at the dimension level was evaluated using Gwet's agreement coefficient (AC1). To assess the differences between the self and the two proxy reports, the Wilcoxon matched-pair signed-rank test was used. RESULTS This study involved 85 child-parent dyads. The agreement between self and proxy overall HRQoL was low (fair) with both proxy-proxy (CCC = 0.28) and proxy-child (CCC = 0.26) reports. The largest discrepancy in the child-proxy agreement at dimension level with both the proxy versions was observed for 'feeling worried, sad or unhappy'. Within this dimension, the proxy-child perspective resulted in a stronger agreement (AC1 = 0.7, good) with child self-report compared with the traditional proxy-proxy perspective (AC1 = 0.58, moderate). Although the preference-weighted HRQoL was consistent across both the proxy perspectives, a significant difference was observed in the EQ VAS scores (p = 0.02). CONCLUSIONS This study demonstrates that choice of proxy perspective may have an impact on the problems reported on HRQoL dimensions and EQ VAS scores. However, in this community-based sample of generally healthy children, no significant difference was observed in the inter-rater agreement for child-self and proxy preference-weighted EQ-5D-Y-3L values based on proxy perspectives. While this suggests that preference-weighted data are not sensitive to the choice of perspective, these findings may differ for different HRQoL instruments and for alternative value sets with different properties.
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Affiliation(s)
- Diana Khanna
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5042, Australia.
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5042, Australia
- Registry of Senior Australians, Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5042, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
| | - Kim Dalziel
- Health Economics Unit, University of Melbourne, Melbourne, VIC, Australia
- Health Services and Economics, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Nancy Devlin
- Health Economics Unit, University of Melbourne, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5042, Australia
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Xie F, Xie S, Pullenayegum E, Ohinmaa A. Understanding Canadian stakeholders' views on measuring and valuing health for children and adolescents: a qualitative study. Qual Life Res 2024; 33:1415-1422. [PMID: 38438665 PMCID: PMC11045599 DOI: 10.1007/s11136-024-03618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Valuing child health is critical to assessing the value of healthcare interventions for children. However, there remain important methodological and normative issues. This qualitative study aimed to understand the views of Canadian stakeholders on these issues. METHODS Stakeholders from health technology assessment (HTA) agencies, pharmaceutical industry representatives, healthcare providers, and academic researchers/scholars were invited to attend an online interview. Semi-structured interviews were designed to focus on: (1) comparing the 3-level and 5-level versions of the EQ-5D-Y; (2) source of preferences for valuation (adults vs. children); (3) perspective of valuation tasks; and (4) methods for valuation (discrete choice experiment [DCE] and its variants versus time trade-off [TTO]). Participants were probed to consider HTA guidelines, cognitive capacity, and potential ethical concerns. All interviews were recorded and transcribed verbatim. Framework analysis with the incidence density method was used to analyze the data. RESULTS Fifteen interviews were conducted between May and September 2022. 66.7% (N = 10) of participants had experience with economic evaluations, and 86.7% (N = 13) were parents. Eleven participants preferred the EQ-5D-Y-5L. 12 participants suggested that adolescents should be directly involved in child health valuation from their own perspective. The participants were split on the ethical concerns. Eight participants did not think that there was ethical concern. 11 participants preferred DCE to TTO. Among the DCE variants, 6 participants preferred the DCE with duration to the DCE with death. CONCLUSIONS Most Canadian stakeholders supported eliciting the preferences of adolescents directly from their own perspective for child health valuation. DCE was preferred if adolescents are directly involved.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Eleanor Pullenayegum
- The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
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Matza LS, Stewart KD, Fournier M, Rowen D, Lachmann R, Scarpa M, Mengel E, Obermeyer T, Ayik E, Laredo F, Pulikottil-Jacob R. Assessment of health state utilities associated with adult and pediatric acid sphingomyelinase deficiency (ASMD). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01667-7. [PMID: 38409492 DOI: 10.1007/s10198-023-01667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/21/2023] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Acid sphingomyelinase deficiency (ASMD) type B is a rare genetic disorder leading to enlargement of the spleen and liver, pulmonary dysfunction, and other symptoms. Cost-utility analyses are often conducted to quantify the value of new treatments, and these analyses require health state utilities. Therefore, the purpose of this study was to estimate utilities associated with varying levels of severity of adult and pediatric ASMD type B. METHODS Seven adult and seven child health state vignettes describing ASMD were developed based on published literature, clinical trial results, and interviews with clinicians, patients with ASMD, and parents of children with ASMD. The health states were valued in time trade-off interviews with adult general population respondents in the UK. RESULTS Interviews were completed with 202 participants (50.0% female; mean age = 41.3 years). The health state representing ASMD without impairment had the highest mean utility for both the adult and child health states (0.92/0.94), and severe ASMD had the lowest mean utility (0.33/0.45). Every child health state had a significantly greater utility than the corresponding adult health state. Differences between adult/child paired states ranged from 0.02 to 0.13. Subgroup analyses explored the impact of parenting status on valuation of child health states. DISCUSSION Greater severity of ASMD was associated with lower mean utility. Results have implications for valuation of pediatric health states. The resulting utilities may be useful in cost-utility modeling estimating the value of treatment for ASMD.
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Affiliation(s)
- Louis S Matza
- Patient-Centered Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | - Katie D Stewart
- Patient-Centered Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | | | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Maurizio Scarpa
- Centro Coordinamento Regionale Malattie Rare, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Eugen Mengel
- SphinCS-Institute of Clinical Science for Lysosomal Storage Diseases, Hochheim, Germany
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Lipman SA, Reckers-Droog VT. Comparing heuristic valuation processes between health state valuation from child and adult perspectives. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01668-6. [PMID: 38308719 DOI: 10.1007/s10198-023-01668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/21/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Health state valuation assumes that respondents trade off between all aspects of choice tasks and maximize their utility. Yet, respondents may use heuristic valuation processes, i.e., strategies to simplify or avoid the trade-offs that are core to health state valuation. The objective of this study is to explore if heuristic valuation processes are more prevalent for valuation from a 10-year-old child's perspective compared to the use of an adult perspective. METHODS We reused existing data in which EQ-5D health states were valued from adult and child perspectives with composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks. Our analyses focused on comparing completion time and responding patterns across both perspectives. We also explored how reflective of a set of heuristic strategies respondents' choices were in both perspectives. RESULTS We found no evidence for systematic differences in completion time across perspectives. Generally, we find different responding patterns in child perspectives, e.g., more speeding, dominance violations, and clustering of utilities at 1.0, 0.8, and 0. Very few heuristic strategies provide a coherent explanation for the observed DCE responses. CONCLUSION Our results provide some, albeit indirect, evidence for differences in heuristic valuation processes between perspectives, although not across all data sources. Potential effects of heuristic valuation processes, such as transfer of responsibility, may be identified through studying responding patterns in cTTO and DCE responses.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Research Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Vivian T Reckers-Droog
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Research Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Yang Z, Devlin NJ, Rand K, Luo N. Testing 2 Alternative Time Trade-Off Methods for Valuation of Children's Health States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:43-50. [PMID: 37813195 DOI: 10.1016/j.jval.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Composite time trade-off (cTTO) values for EQ-5D-Y-3L health states tend to be high, raising concerns about sensitivity particularly for mild or moderate health states. We conceptualized and pilot tested 2 alternative time trade-off (TTO) variants: the caregiver TTO (CGTTO) and lag-time TTO (LTTO). METHODS We collected CGTTO and LTTO data in China for 10 EQ-5D-Y-3L health states and compared the resulting values, respondent feedback, and task completion times with those from an EQ-5D-Y-3L valuation study using cTTO. We also examined how age and parental status of respondents could affect TTO values. RESULTS A total of 304 participants were included in this study. Overall, cTTO showed statistically better results in all feedback questions. On a 5-point Likert scale where lower score means greater agreement, the mean (SD) feedback scores for cTTO, LTTO, and CGTTO were 1.18 (0.58), 1.45 (0.91), and 1.65 (1.02) for "easy to understand"; 1.45 (0.91), 1.94 (1.08), and 1.86 (1.24) for "easy to differentiate"; and 3.61 (1.29), 2.97 (1.33), and 3.02 (1.50) for "difficult to decide," respectively. The mean (SD) TTO values of all 10 states were 0.463 (0.494), 0.387 (0.555), and 0.123 (0.710) for cTTO, LTTO, and CGTTO, respectively. The effects of age and parental status on TTO values differed by the 3 methods. CONCLUSIONS LTTO and CGTTO produce values with good characteristics and merit further investigation. Researchers need to be aware of the differences in design and values when using the TTO method to value children's health states.
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Affiliation(s)
- Zhihao Yang
- Department of Health Services Management, Guizhou Medical University, Guiyang, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Nancy J Devlin
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Rand
- Health Services Research Centre, Akershus University Hospital, Oslo, Norway; Maths in Health B.V., Rotterdam, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Attema AE, Lang Z, Lipman SA. Can Independently Elicited Adult- and Child-Perspective Health-State Utilities Explain Priority Setting? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1645-1654. [PMID: 37659690 DOI: 10.1016/j.jval.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES Time trade-off (TTO) utilities for EQ-5D-Y-3L health states valued by adults taking a child's perspective are generally higher than their valuations of the same state for themselves. Ceteris paribus, the use of these utilities in economic evaluation implies that children gain less from treatments returning them to full health for a specified amount of time than adults. In this study, we explore if this implication affects individuals' views of priority-setting choices between treatments for adults and children. METHODS We elicited TTO utilities for 4 health states in online interviews, in which respondents valued states for a 10-year-old child and another adult their age. Views on priority setting were studied with person trade-off (PTO) tasks involving the same health states. We tested the ability of the subjects' TTO utilities to predict these societal choices in PTO. RESULTS There are no significant differences between adult and child health state valuations in our study, but we do observe a substantial preference for treating children over adults in the PTO task. CONCLUSIONS Our findings suggest that perspective-dependent health-state utilities only explain a small part of views on priority setting between adults and children. External equity weights might be useful to better explain the higher priority given to children.
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Affiliation(s)
- Arthur E Attema
- EsCHER, Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands.
| | - Zhongyu Lang
- EsCHER, Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands
| | - Stefan A Lipman
- EsCHER, Erasmus School of Health Policy & Management (ESHPM), Erasmus University, Rotterdam, The Netherlands
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Essers B, Wang P, Stolk E, Jonker MF, Evers S, Joore M, Dirksen C. An investigation of age dependency in Dutch and Chinese values for EQ-5D-Y. Front Psychol 2023; 14:1175402. [PMID: 37860294 PMCID: PMC10583565 DOI: 10.3389/fpsyg.2023.1175402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
Aims The primary aim was to explore the age dependency of health state values derived via trade-offs between health-related quality of life (HRQoL) and life years in a discrete choice experiment (DCE). The secondary aim was to explore if people weigh life years and HRQoL differently for children, adolescents, adults, and older adults. Methods Participants from the general population of the Netherlands and China first completed a series of choice tasks offering choices between two EQ-5D-Y states with a given lifespan. The choice model captured the value of a year in full health, disutility determined by EQ-5D-Y, and a discount rate. Next, they received a slightly different choice task, offering choices between two lives that differed in HRQoL and life expectancy but produced the same number of quality-adjusted life years (QALYs). Participants were randomly assigned to fill out the survey for three or four age frames: a hypothetical person of 10, 15, 40, and 70 years (the last one only applicable to China) to allow the age dependency of the responses to be explored. Results A total of 1,234 Dutch and 1,818 Chinese people administered the survey. Controlling for time preferences, we found that the agreement of health state values for different age frames was generally stronger in the Netherlands than in China. We found no clear pattern of differences in the QALY composition in both samples. The probability distribution over response options varied most when levels for lifespan or severity were at the extremes of the spectrum. Conclusion/discussion The magnitude and direction of age effects on values seemed dimension- and country specific. In the Netherlands, we found a few differences in dimension-specific weights elicited for 10- and 15-year-olds compared to 40-year-olds, but the overall age dependency of values was limited. A stronger age dependency of values was observed in China, where values for 70-year-olds differed strongly from the values for other ages. The appropriateness of using existing values beyond the age range for which they were measured needs to be evaluated in the local context.
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Affiliation(s)
- Brigitte Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, Netherlands
| | - Marcel F. Jonker
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Silvia Evers
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
| | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
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Devlin NJ, Pan T, Sculpher M, Jit M, Stolk E, Rowen D, van Hout B, Norman R. Using Age-Specific Values for Pediatric HRQoL in Cost-Effectiveness Analysis: Is There a Problem to Be Solved? If So, How? PHARMACOECONOMICS 2023; 41:1165-1174. [PMID: 37439998 PMCID: PMC10492668 DOI: 10.1007/s40273-023-01300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/14/2023]
Abstract
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.
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Affiliation(s)
- Nancy J Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, VIC, 3010, Australia.
| | - Tianxin Pan
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, VIC, 3010, Australia
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Barend van Hout
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
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Sharma D, Prinja S, Aggarwal AK, Rajsekar K, Bahuguna P. Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 16:100241. [PMID: 37694178 PMCID: PMC10485782 DOI: 10.1016/j.lansea.2023.100241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 09/12/2023]
Abstract
Background Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Methods Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. Findings The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. Interpretation The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. Funding This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India.
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Affiliation(s)
- Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun K. Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Xu X, Shao X, Cao J, Huang X, Li L. Contact aspiration and stent retriever versus stent retriever alone following mechanical thrombectomy for patients of acute ischemic stroke: A recanalization success analysis. Clinics (Sao Paulo) 2023; 78:100262. [PMID: 37633124 PMCID: PMC10470391 DOI: 10.1016/j.clinsp.2023.100262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVE Second-generation catheters used in mechanical thrombectomy have different advantages and disadvantages. The objective of this study was to evaluate the effectiveness and safety of the combination of contact aspiration and stent retriever technique on the rate of reperfusion after mechanical thrombectomy for large vessel occlusion. METHODS Patients who underwent contact aspiration alone (CAA cohort, n = 150), stent retriever alone (SRA cohort, n = 129), or combined contact aspiration and stent retriever (CSR cohort, n = 122) techniques following mechanical thrombectomy were included in the analysis. A balloon guide catheter was used for all thrombectomies. Digital subtraction angiography was used to identify thrombolysis in cerebral infarction. RESULTS The number of patients with thrombolysis in cerebral infarction score of ≥ 2c (near complete or complete antegrade reperfusion) was significantly higher in the CSR cohort than those in the CAA cohort (101 [83%] vs. 90 [60%], p < 0.0001) and those of SRA cohort (101 [83%] vs. 77 [59%], p = 0.0001). Arterial perforation was higher in patients in the CSR cohort than in those in the CAA (p < 0.0001) and SRA (p = 0.015) cohorts. Intracerebral hemorrhage was lower in patients in the CSR cohort than in those in the CAA (p = 0.0001) and SRA (p = 0.0353) cohorts. All-cause mortality at 1 year was fewer in the CSR cohort than in the CAA cohort (p = 0.018). CONCLUSIONS The combination of thrombo aspiration by large bore aspiration catheter and stent retriever is the most effective technique but has some related risks. LEVEL OF EVIDENCE IV. TECHNICAL EFFICACY STAGE 1.
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Affiliation(s)
- Xiaowei Xu
- Department of Neurology, Haian People's Hospital, Haian, Jiangsu, China
| | - Xiangzhong Shao
- Department of Neurology, Haian People's Hospital, Haian, Jiangsu, China.
| | - Jian Cao
- Department of Neurology, Haian People's Hospital, Haian, Jiangsu, China
| | - Xiaoyong Huang
- Department of Neurology, Haian People's Hospital, Haian, Jiangsu, China
| | - Lin Li
- Department of Neurology, Haian People's Hospital, Haian, Jiangsu, China
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Yu A, Luo Y, Bahrampour M, Norman R, Street D, Viney R, Devlin N, Mulhern BJ. Understanding the valuation of paediatric health-related quality of life: a qualitative study protocol. BMJ Open 2023; 13:e073039. [PMID: 37532476 PMCID: PMC10401228 DOI: 10.1136/bmjopen-2023-073039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION There is evidence from previous studies that adults value paediatric health-related quality of life (HRQoL) and adult HRQoL differently. Less is known about how adolescents value paediatric HRQoL and whether their valuation and decision-making processes differ from those of adults. Discrete choice experiments (DCEs) are widely used to develop value sets for measures of HRQoL, but there is still much to understand about whether and how the methods choices in the implementation of DCE valuation tasks, such as format, presentation and perspective, affect the decision-making process of participants. This paper describes the protocol for a qualitative study that aims to explore the decision-making process of adults and adolescents when completing DCE valuation tasks. The study will also explore the impact of methodological choices in the design of DCE studies (including decisions about format and presentation) on participants' thinking process. METHODS AND ANALYSIS An interview protocol has been developed using DCE valuation tasks. Interviews will be conducted online via Zoom with both an adolescent and adult sample. In the interview, the participant will be asked to go through some DCE valuation tasks while 'thinking aloud'. After completion of the survey, participants will then be asked some predetermined questions in relation to various aspects of the DCE tasks. Interviews will be recorded and transcribed and analysed using a thematic analysis approach. ETHICS AND DISSEMINATION Ethics approval for this study has been received for the adult sample (UTS ETH20-9632) as well as the youth sample (UTS ETH22-6970) from the University of Technology Sydney Human Research Ethics Committee. Results from this study will inform the methods to be used in development of value sets for use in the health technology assessment of paediatric interventions and treatments. Findings from this study will also be disseminated through national/international conferences and peer-reviewed journals.
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Affiliation(s)
- Alice Yu
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Yiting Luo
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Mina Bahrampour
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | | | - Deborah Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Nancy Devlin
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brendan James Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
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Yang Z, Jiang J, Wang P, Wu J, Fang Y, Feng D, Xi X, Luo N. Using Time Trade-Off Values to Estimate EQ-5D-Y Value Sets: An Exploratory Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:968-973. [PMID: 36921897 DOI: 10.1016/j.jval.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/13/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The published international EQ-5D-Y-3L valuation protocol does not recommend the composite time trade-off (cTTO) method as the primary valuation method because of 2 major concerns. First, the cTTO method was shown to generate high values. Second, the cTTO method is not as feasible for valuing children's health as other established methods. This study aimed to explore the feasibility of using cTTO values alone to estimate EQ-5D-Y-3L value sets. METHODS We analyzed the cTTO data derived from the recently completed Chinese EQ-5D-Y-3L valuation study in which a total of 28 health states were valued. We assessed the feasibility of the cTTO tasks in terms of survey completion time and participant-reported difficulty of understanding the task, differentiating the health states, and deciding the answer. We also examined the data distribution characteristics and modeled the data using different models. RESULTS In total, 418 participants completed the cTTO interview. On average, participants took approximately 35.70 minutes (SD 12.42) to complete the interview and made 13.21 moves (SD 9.00) in the cTTO tasks. There were 74.16%, 59.33%, and 11.48% of participants indicated that it was easy to understand the cTTO tasks, easy to differentiate between the health states, and difficult to decide on an indifference point, respectively. The data distribution was smooth, and a random-effects model performed the best in terms of coefficient significance, monotonicity, and predictive accuracy. CONCLUSION Our finding suggests that estimating EQ-5D-Y-3L value sets using cTTO data alone is feasible and therefore could be considered as an option in future valuation studies for EQ-5D-Y-3L.
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Affiliation(s)
- Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Gui'an, China; College of Pharmacy, Jinan University, Guangzhou, China
| | - Jie Jiang
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Yu Fang
- Department of Pharmacy Administration, School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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14
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Lipman SA, Zhang L, Shah KK, Attema AE. Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:293-305. [PMID: 35596831 PMCID: PMC9123877 DOI: 10.1007/s10198-022-01466-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/12/2022] [Indexed: 05/21/2023]
Abstract
In the valuation of EQ-5D-Y-3L, adult respondents are asked to complete composite time trade-off (cTTO) tasks for a 10-year-old child. Earlier work has shown that cTTO utilities elicited in such a child perspective are generally higher than when adults take their own perspective. We explore how differences in time preference in child and adult perspectives could explain this effect. Furthermore, as cTTO valuation in a child perspective involves explicit consideration of immediate death for a child, we also consider how cTTO utilities could be affected by decision-makers lexicographically avoiding death in children. We report the results of an experiment in which 219 respondents valued 5 health states in both adult and child perspectives with either a standard cTTO or a lead-time TTO only approach, in which immediate death is less focal. Time preferences were measured in both perspectives. Our results suggest that utilities were lower when lead-time TTO, rather than cTTO, was used. We find large heterogeneity in time preference in both perspectives, with predominantly negative time preference. The influence of time preferences on utilities, however, was small, and correcting for time preferences did not reduce differences between utilities elicited in both perspectives. Surprisingly, we found more evidence for differences in utilities between adult and child perspectives when lead-time TTO was used. Overall, these results suggest that time and lexicographic preferences affect time trade-off valuation in child and adult perspectives, but are not the explanation for differences between these perspectives. We discuss the implications of our findings for EQ-5D-Y-3L valuation.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Liying Zhang
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Koonal K Shah
- National Institute for Health and Care Excellence, London, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- PHMR Ltd, London, UK
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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15
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Lipman SA, Zhang L, Shah KK, Attema AE. Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:293-305. [PMID: 35596831 DOI: 10.1007/s10198-022-01466-6:1-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/12/2022] [Indexed: 05/24/2023]
Abstract
In the valuation of EQ-5D-Y-3L, adult respondents are asked to complete composite time trade-off (cTTO) tasks for a 10-year-old child. Earlier work has shown that cTTO utilities elicited in such a child perspective are generally higher than when adults take their own perspective. We explore how differences in time preference in child and adult perspectives could explain this effect. Furthermore, as cTTO valuation in a child perspective involves explicit consideration of immediate death for a child, we also consider how cTTO utilities could be affected by decision-makers lexicographically avoiding death in children. We report the results of an experiment in which 219 respondents valued 5 health states in both adult and child perspectives with either a standard cTTO or a lead-time TTO only approach, in which immediate death is less focal. Time preferences were measured in both perspectives. Our results suggest that utilities were lower when lead-time TTO, rather than cTTO, was used. We find large heterogeneity in time preference in both perspectives, with predominantly negative time preference. The influence of time preferences on utilities, however, was small, and correcting for time preferences did not reduce differences between utilities elicited in both perspectives. Surprisingly, we found more evidence for differences in utilities between adult and child perspectives when lead-time TTO was used. Overall, these results suggest that time and lexicographic preferences affect time trade-off valuation in child and adult perspectives, but are not the explanation for differences between these perspectives. We discuss the implications of our findings for EQ-5D-Y-3L valuation.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Liying Zhang
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Koonal K Shah
- National Institute for Health and Care Excellence, London, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- PHMR Ltd, London, UK
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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16
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Roudijk B, Sajjad A, Essers B, Lipman S, Stalmeier P, Finch AP. A Value Set for the EQ-5D-Y-3L in the Netherlands. PHARMACOECONOMICS 2022; 40:193-203. [PMID: 36216977 PMCID: PMC9549846 DOI: 10.1007/s40273-022-01192-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND OBJECTIVE There is increasing interest in preference-accompanied measures of health for paediatric populations. The child-friendly EQ-5D version, EQ-5D-Y-3L, is one such instrument, but the lack of a Dutch value set prevents its use in economic evaluations of healthcare interventions in the Netherlands. This study aims at covering this gap by collecting preferences using a standardised protocol for deriving EQ-5D-Y-3L value sets. METHODS Composite time trade-off data were collected using videoconferencing interviews, with each respondent completing ten composite time trade-off tasks. Discrete choice experiment data were collected using an online survey, with respondents each completing 15 paired comparisons. Respondents completed these tasks considering what they prefer for a hypothetical 10-year-old child. Discrete choice experiment data were analysed using a ten-parameter mixed-logit model and anchored to the quality-adjusted life-year scale using the mean observed composite time trade-off values. RESULTS The study collected preferences for 197 respondents using composite time trade-off and for 959 respondents using a discrete choice experiment. The discrete choice experiment sample was representative for the Dutch population in terms of age and sex. The level 3 weight for pain/discomfort was the largest, followed by feeling worried, sad or unhappy, usual activities, mobility and self-care. Health state values ranged between -0.218 and 1. CONCLUSIONS This study generated a Dutch value set for the EQ-5D-Y-3L, which can be used for the computation of quality-adjusted life-years for economic evaluations of healthcare interventions in paediatric populations.
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Affiliation(s)
- Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands.
| | - Ayesha Sajjad
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Brigitte Essers
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stefan Lipman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Peep Stalmeier
- Radboud University Medical Center, Nijmegen, The Netherlands
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Dewilde S, Roudijk B, Tollenaar NH, Ramos-Goñi JM. An EQ-5D-Y-3L Value Set for Belgium. PHARMACOECONOMICS 2022; 40:169-180. [PMID: 36316544 PMCID: PMC9628592 DOI: 10.1007/s40273-022-01187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND In Belgium, a value set for children and adolescents for a generic health-related quality-of-life measure is not available. To inform drug pricing and make resource allocation decisions for children and adolescents, national tax-payers' preferences for youth health states should be known. OBJECTIVE We aimed to obtain a value set for EQ-5D-Y-3L in Belgium, following the international youth valuation protocol for data collection. METHODS Composite Time Trade-Off interviews were conducted in a sample of 200 adults, either face to face or via video conferencing. Another sample of 1000 adults completed an online discrete choice experiment survey. All adults were asked to take the perspective of a 10-year-old child for both methods. Both samples were representative for Belgium in terms of age, sex and region. A latent class analysis was selected to obtain the relative importance of the five dimensions and their levels based on the discrete choice experiment data, which were anchored with the composite Time Trade-Off censored value for the worst health state (33333). RESULTS Preferences from Belgian adults revealed a mean censored value for 33333 for children and adolescents of - 0.475. All the estimated coefficients of the model with 4 latent classes were statistically significant and showed higher disutility as severity levels increase. The most important health dimension was pain/discomfort, followed by feeling sad/worried/unhappy. CONCLUSIONS This study presents the Belgian EQ-5D-Y-3L value set, which will be included in the Belgian pharmacoeconomic guidelines. The value set enables the calculation of quality-adjusted life-years in children and adolescents, allowing a cost-effectiveness evaluation of health technologies and their youth-specific price setting.
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Affiliation(s)
- Sarah Dewilde
- Services in Health Economics, Rue des Eburons 55, 1000, Brussels, Belgium.
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
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Lipman SA, Essers BAB, Finch AP, Sajjad A, Stalmeier PFM, Roudijk B. In a Child's Shoes: Composite Time Trade-Off Valuations for EQ-5D-Y-3L with Different Proxy Perspectives. PHARMACOECONOMICS 2022; 40:181-192. [PMID: 36255560 PMCID: PMC9579618 DOI: 10.1007/s40273-022-01202-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVES EQ-5D-Y-3L health states are commonly valued by asking adults to complete stated preference tasks, 'given their views about a 10-year-old child' (hereafter referred to as proxy 1). The use of this perspective has been a source of debate. In this paper, we investigated an alternative proxy perspective: i.e. adults considered what they think a 10-year old-child would decide for itself (hereafter, proxy 2 (substitute)]. Our main objective was to explore how the outcomes, dispersion and response patterns of a composite time trade-off valuation differ between proxy 1 and proxy 2. METHODS A team of four trained interviewers completed 402 composite time trade-off interviews following the EQ-5D-Y-3L protocol. Respondents were randomly allocated to value health states in either the proxy 1 or proxy 2 (substitute) perspective. Each respondent valued ten health states with the perspective they were assigned to, as well as one health state with the alternative perspective (33333). RESULTS The use of different proxy perspectives yielded differences in EQ-5D-Y-3L valuation. For states in which children had considerable pain and were very worried, sad or unhappy, respondents' valuations were lower in proxy 1 than in proxy 2 (substitute) perspectives, by about 0.2. Within-subject variation across health states was lower for proxy 2 (substitute) than proxy 1 perspectives. Analyses of response patterns suggest that data for proxy 2 (substitute) perspectives were less clustered. CONCLUSIONS There are systematic differences between composite time trade-off responses given by adults deciding for children and adults considering what children would want for themselves. In addition to warranting further qualitative exploration, such differences contribute to the ongoing normative discussion surrounding the source and perspective used for valuation of child and adolescent health.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
| | - Brigitte A B Essers
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Ayesha Sajjad
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Peep F M Stalmeier
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
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Rencz F, Ruzsa G, Bató A, Yang Z, Finch AP, Brodszky V. Value Set for the EQ-5D-Y-3L in Hungary. PHARMACOECONOMICS 2022; 40:205-215. [PMID: 36123448 PMCID: PMC9485017 DOI: 10.1007/s40273-022-01190-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND The Hungarian health technology assessment guidelines recommend the use of the EuroQol instrument family in quality-adjusted life-year calculations. However, no national value set exists for the EQ-5D-Y-3L or any other youth-specific instrument. OBJECTIVE This study aims to develop a national value set of the EQ-5D-Y-3L for Hungary based on preferences of the general adult population. METHODS This study followed the international valuation protocol for the EQ-5D-Y-3L. Two independent samples, representative of the Hungarian general adult population in terms of age and sex were recruited to complete online discrete choice experiment (DCE) tasks and composite time trade-off (cTTO) tasks by computer-assisted personal interviews. Adults valued hypothetical EQ-5D-Y-3L health states considering the health of a 10-year-old child. DCE data were modelled using a mixed logit model with random-correlated coefficients. Latent DCE utility estimates were mapped onto mean observed cTTO utilities using ordinary least squares regression. RESULTS Overall, 996 and 200 respondents completed the DCE and cTTO surveys, respectively. For each domain, the value set resulted in larger utility decrements with more severe response levels. The relative importance of domains by level 3 coefficients was as follows: having pain or discomfort > feeling worried, sad or unhappy > mobility > doing usual activities > looking after myself. Overall, 12.3% of all health states had negative utilities in the value set, with the worst health state having the lowest predicted utility of - 0.485. CONCLUSION This study developed a national value set of the EQ-5D-Y-3L for Hungary. The value set enables to evaluate the cost utility of health technologies for children and adolescents based on societal preferences in Hungary.
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Affiliation(s)
- Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary.
| | - Gábor Ruzsa
- Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Alex Bató
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China
| | | | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, 1093, Budapest, Hungary
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Mott DJ, Devlin NJ, Kreimeier S, Norman R, Shah KK, Rivero-Arias O. Analytical Considerations When Anchoring Discrete Choice Experiment Values Using Composite Time Trade-Off Data: The Case of EQ-5D-Y-3L. PHARMACOECONOMICS 2022; 40:129-137. [PMID: 36396877 PMCID: PMC9758092 DOI: 10.1007/s40273-022-01214-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Discrete choice experiments (DCEs) are becoming increasingly used to elicit preferences for children's health states. However, DCE data need to be anchored to produce value sets, and composite time trade-off (cTTO) data are typically used in the context of EQ-5D-Y-3L valuation. The objective of this paper is to compare different anchoring methods, summarise the characteristics of the value sets they produce, and outline key considerations for analysts. Three anchoring methods were compared using data from published studies: (1) rescaling using the mean value for the worst health state; (2) linear mapping; and (3) hybrid modelling. The worst state rescaling value set had the largest range. The worst state rescaling and linear mapping value sets preserved the relative importance of the dimensions from the DCE, whereas the hybrid model value set did not. Overall, the predicted values from the hybrid model value set were more closely aligned with the cTTO values. These findings are relatively generalisable. Deciding upon which anchoring approach to use is challenging, as there are numerous considerations. Where cTTO data are collected for more than one health state, anchoring on the worst health state will arguably be suboptimal. However, the final choice of approach may require value judgements to be made. Researchers should seek input from relevant stakeholders when commencing valuation studies to help guide decisions and should clearly set out their rationale for their preferred anchoring approach in study outputs.
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Affiliation(s)
| | - Nancy J Devlin
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Simone Kreimeier
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Koonal K Shah
- National Institute of Health and Care Excellence, London, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Nazari JL, Pickard AS, Gu NY. Findings from a Roundtable Discussion with US Stakeholders on Valuation of the EQ-5D-Y-3L. PHARMACOECONOMICS 2022; 40:139-146. [PMID: 36443519 PMCID: PMC9758239 DOI: 10.1007/s40273-022-01222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVES The International Valuation Protocol for the valuation of the EQ-5D-Y-3L provides baseline guidance, but country-specific context is also important. This study aimed to obtain US stakeholders' input on key considerations for youth valuation in the US. METHODS A total of 14 stakeholders representing various backgrounds were identified via the investigators' networks. A 2-h online meeting was held to discuss (1) the need for a US value set for the EQ-5D-Y-3L; (2) willingness to pay more for quality-adjusted life-year (QALY) gains for children versus adults; (3) sampling strategies; (4) framing perspectives; and (5) other challenges. The session was recorded, transcribed, and summarized. RESULTS Several stakeholders supported paying more for QALY gains for children in recognition of their potential future contributions to society, as well as to avoid potential undervaluation and promote access to innovative treatments. Concerns regarding possible double counting, lack of data to showcase long-term benefits, and dangers of paying more for certain subgroups were also expressed. Most of the stakeholders felt that adolescents could relate to a 10-year-old's perspective better than adults and were capable of self-completing valuation tasks, and thus should be directly included in the valuation study. There were concerns that adults would be inconsistent in their views about a 10-year-old, partly depending on their status as a parent. CONCLUSIONS US stakeholders provided insights relevant to youth valuation in a US context and were open to continued dialogue with investigators. This study could be useful to investigators who are conducting youth valuation studies in different countries and seeking stakeholder input.
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Affiliation(s)
- Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Ning Yan Gu
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA.
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22
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Kreimeier S, Mott D, Ludwig K, Greiner W. EQ-5D-Y Value Set for Germany. PHARMACOECONOMICS 2022; 40:217-229. [PMID: 35604633 PMCID: PMC9124748 DOI: 10.1007/s40273-022-01143-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Demand is increasing for youth-specific preference-based health-related quality-of-life measures for inclusion in evaluations of healthcare interventions for children and adolescents. The EQ-5D-Youth (EQ-5D-Y) has the potential to become such a preference-based measure. OBJECTIVE This study applied the recently published EQ-5D-Y valuation protocol to develop a German EQ-5D-Y value set and explored the differences between values given to youth health by parents and non-parents. METHODS To elicit EQ-5D-Y health state preferences, a representative sample of 1030 adults of the general population completed a discrete choice experiment (DCE) online survey, and 215 adults participated in face-to-face interviews applying composite time trade-off (cTTO). Respondents were asked to consider a 10-year-old child living in the health states. DCE data were modelled using a mixed logit model. To derive the value set, DCE latent scale values were anchored onto adjusted mean cTTO values using a linear mapping approach. RESULTS Adult respondents considered pain/discomfort and feeling worried/sad/unhappy as the two most important dimensions in terms of youth health. Adjusted mean cTTO values ranged from - 0.350 for health state 33333 to 0.970 for health state 21111. The EQ-5D-Y value set showed a logical order for all parameter estimates, and predicted values ranged from - 0.283 to 1. Differences in preferences by parental status were mainly observed for cTTO results, where mean values were larger for parents than for non-parents. CONCLUSIONS Applying the valuation protocol, a German EQ-5D-Y value set with internally consistent coefficients was developed. This enables the instrument to be used in economic evaluations of paediatric healthcare interventions.
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Affiliation(s)
- Simone Kreimeier
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | | | - Kristina Ludwig
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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23
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Yang Z, Jiang J, Wang P, Jin X, Wu J, Fang Y, Feng D, Xi X, Li S, Jing M, Zheng B, Huang W, Luo N. Estimating an EQ-5D-Y-3L Value Set for China. PHARMACOECONOMICS 2022; 40:147-155. [PMID: 36396878 PMCID: PMC9758244 DOI: 10.1007/s40273-022-01216-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 05/08/2023]
Abstract
INTRODUCTION The standard EQ-5D-Y-3L valuation protocol applies DCE data as the primary preference source to model the relative importance of dimensions while cTTO data served to anchor the DCE coefficients onto the QALY scale. This study aims to estimate an EQ-5D-Y-3L value set for China following this protocol, but with a larger cTTO design to better understand the role of cTTO data in estimating EQ-5D-Y-3L value sets. METHODS In total, 150 choice sets and 28 EQ-5D-Y-3L health states were valued using DCE and cTTO methods with two independent samples, respectively. General public from 14 different regions were recruited using quota sampling method to achieve representativeness. We compared two modelling strategies: (1) fit the DCE data with mixed logit model with correlated coefficients and a subsequent mapping procedure for anchoring; (2) fit the DCE and TTO data jointly in a hybrid model. Two evaluation criteria (1) coefficient significance and monotonicity; (2) prediction accuracy of the observed cTTO values were used to select the value set. RESULTS In total, 1476 individuals participated in the study, with 1058 participated the DCE interview and 418 participated the cTTO interview. The highest mean TTO value was 0.924 for state 11112 and the lowest mean TTO value was - 0.088 for state 33333. The hybrid model with an A3 term performed the best and was selected as the value set. DISCUSSION Following the international protocol and using a larger cTTO design, this study established the EQ-5D-Y-3L value set using a hybrid model for China. Future EQ-5D-Y-3L valuation study could consider using a larger cTTO design for estimating the value set.
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Affiliation(s)
- Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Gui'an, China.
- College of Pharmacy, Jinan University, Guangzhou, China.
| | - Jie Jiang
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Xuejing Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Yu Fang
- Department of Pharmacy Administration, School of Pharmacy, Health Science Centre, Xi'an Jiaotong University, Xi'an, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Xi
- The Research Centre of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingxia Jing
- Department of Preventive Medicine, Medical College of Shihezi University, Shihezi, China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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24
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Lin J, Wong CKH, Cheung JPY, Cheung PWH, Luo N. Psychometric performance of proxy-reported EQ-5D youth version 5-level (EQ-5D-Y-5L) in comparison with three-level (EQ-5D-Y-3L) in children and adolescents with scoliosis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1383-1395. [PMID: 35122171 DOI: 10.1007/s10198-022-01435-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To assess the psychometric performance of proxy-reported EQ-5D-Y-5L (Y-5L) in comparisons with EQ-5D-Y-3L (Y-3L) administered by caregivers of patients with juvenile (JIS) or adolescent idiopathic scoliosis (AIS). METHODS A consecutive sample of caregivers of JIS or AIS patients were recruited. Redistribution property, ceiling effects, and discriminative power were examined. Known-group validity was determined by examining their ability to detect differences across clinical known groups. Test-retest reliability was assessed using intraclass correlation coefficient (ICC) for EQ-VAS score and Gwet's agreement coefficient (GAC) and percentage agreement (PA) for dimension responses. Furthermore, subgroups were analyzed for comparing test-retest reliability. RESULTS A total of 130 caregivers were involved in the study. Consistencies between proxy-reported Y-3L and Y-5L were very high for all dimensions (93.8-99.2%). The ceiling effect in the Y-5L was slightly reduced in four dimensions (AR: 0.8-2.3%) whereas increased in "Having pain/discomfort". Greater informativity was found in the Y-5L than the Y-3L. In known-group comparisons of curvature magnitude, curvature type, and treatment modality, Y-5L and Y-3L dimension scales showed hypothesized results. For example, more full-health responses were found in the mild Cobb angle group (Y-5L: 63.1%; Y-3L: 62.2%) than the severe Cobb angle group (Y-5L: 55.6%, Y-3L: 55.6%). EQ-VAS score exhibited low test-retest reliability (ICC: 0.41), whereas dimension scales of both instruments showed satisfactory test-retest reliability (GAC ≥ 0.7 and PA ≥ 70% for all). In most known groups, hard-to-observe dimensions were more reliable for proxy-reported Y-5L than Y-3L. CONCLUSION Both the proxy-reported Y-5L and Y-3L are valid and reliable instruments for assessing the HRQoL of JIS or AIS patients.
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Affiliation(s)
- Jiaer Lin
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Rm 1‑01, 1/F, Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong SAR, Rm 1-01, 1/F, Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 5/F Professorial Block, Pokfulam, Hong Kong SAR, China.
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 5/F Professorial Block, Pokfulam, Hong Kong SAR, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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25
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Shao G, Wang J, Zhou X, Sun G, Dong Z. Cost-effectiveness analysis of drug-eluting beads and conventional transarterial chemoembolization in the treatment of hepatocellular carcinoma. Front Public Health 2022; 10:963058. [PMID: 36388345 PMCID: PMC9643739 DOI: 10.3389/fpubh.2022.963058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/18/2022] [Indexed: 01/24/2023] Open
Abstract
Objective To conduct a cost-effectiveness analysis of drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) and conventional transcatheter arterial chemoembolization (cTACE) for first-line treatment of hepatocellular carcinoma (HCC) from the perspective of the Chinese healthcare system. Methods Based on the real-world clinical data of HCC patients receiving interventional therapy, a partitioned survival model was constructed for cost-effectiveness analysis. The model period is 1 month, and the research time limit is 10 years. The incremental cost-effectiveness ratio (ICER) is used as the evaluation index. One-way sensitivity analysis and probabilistic sensitivity analysis were used to analyze the uncertainty of parameters to test the stability of the model results. Results The ICER of the DEB-TACE group was 11,875.62 $/QALYs, which was lower than the willingness to pay threshold (WTP) of 31,499.23 $/QALYs. One-way sensitivity analysis suggested that the utility value of progression-free survival (PFS) in the DEB-TACE group had the greatest impact. Probabilistic sensitivity analysis showed that at the level of WTP of 31,499.23 $/QALYs, DEB-TACE had a cost-effective probability of 92%. Conclusion Under the current economic level in my country, DEB-TACE is more cost-effective than cTACE in the treatment of HCC patients.
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Affiliation(s)
- Guoliang Shao
- Interventional Therapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China,Precision Innovation Center of the Diagnosis and Treatment of Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, China
| | - Jingwen Wang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Xiaoying Zhou
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Guojun Sun
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Zuojun Dong
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China,*Correspondence: Zuojun Dong
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26
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Kaso AW, Tesema HG, Hareru HE, Kaso T, Ashuro Z, Talemahu AA, Jore ST, Kassa R, Agero G, Hailu A. Health-Related Quality of Life and Associated Factors Among Covid-19 Survivors. Experience from Ethiopian Treatment Centers. Infect Drug Resist 2022; 15:6143-6153. [PMID: 36304968 PMCID: PMC9593469 DOI: 10.2147/idr.s386566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background The pandemic of the novel coronavirus (Covid-19), which is extremely stressful and has an adverse effect on people's health-related quality of life (HRQoL), poses a serious threat to global public health. As a result, this study evaluated the health-related quality of life and associated factors among Covid-19 patients who were discharged from Ethiopian treatment centers. Methods We conducted a multi-center, cross-sectional study among 493 Covid-19 survivors who had been discharged from treatment centers between 1st January 2020, and 20th October 2021. We collected respondents' data using validated Amharic version EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients. Differences in HRQOL scores between patient subgroups were tested by Mann-Whitney U or Kruskal-Wallis test, and the multivariable betaMix regression was used to investigate factors associated with HRQOL scores. Results The EQ-5D and VAS median score for Covid-19 survivors was 0.940 (IQR: 0.783-0.966) and 87 (IQR: 70-91) respectively. Overall, married individuals, old-aged, individuals who had low educational status, high monthly income, comorbidities, admitted to the Intensive care Unit, received intranasal oxygen care, and prolonged hospitalization had lower utility scores and EQ-VAS scores compared to their counterparts. In multivariate betaMix regression, respondents' health status at admission, old age, chronic obstructive pulmonary disease, asthma, and hospital length of stay were significantly associated with the lower EQ-5D-Index value and EQ-VAS score. Conclusion We found that Covid-19 infection had a persisting impact on the physical and psychosocial health of Covid-19 survivors. Age, having asthma and chronic obstructive pulmonary disease, having a worsening health state upon admission, and a prolonged hospital length of stay were significantly associated with the lower EQ-5D and EQ-VAS score. Therefore, the cost-effective psychological treatment such as cognitive behaviour therapy should be encouraged after hospitalization to improve the post-Covid-19 depression and fatigue.
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Affiliation(s)
- Abdene Weya Kaso
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia,Correspondence: Abdene Weya Kaso, Email
| | - Hailmariam Getachew Tesema
- Department of Anaesthesiology, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Habtamu Endashaw Hareru
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Taha Kaso
- Department of Surgery, College of Health Science, Arsi University, Asella, Ethiopia
| | - Zemachu Ashuro
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Adugna Asefa Talemahu
- School of Medicine, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Soressa Tafere Jore
- School of Medicine, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Reta Kassa
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Alemayehu Hailu
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Devlin N, Pan T, Kreimeier S, Verstraete J, Stolk E, Rand K, Herdman M. Valuing EQ-5D-Y: the current state of play. Health Qual Life Outcomes 2022; 20:105. [PMID: 35794607 PMCID: PMC9260978 DOI: 10.1186/s12955-022-01998-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND For nearly a decade, value sets for the EQ-5D-Y were not available, reflecting challenges in valuing child HRQoL. A methodological research programme led to publication of a valuation protocol in 2020, which was rapidly taken up by local study teams. By the end of 2022, between 11 and 17 EQ-5D-Y value sets will be available, more than for any other child HRQoL measure. It is timely to review the experience of those using the protocol to identify early learnings and remaining issues where more research is needed. METHODS In June 2021, the EuroQol Group organised a three-day workshop, bringing together all those involved in EQ-5D-Y value set studies and related methodological research concerning EQ-5D-Y and valuation. Workshop discussions were captured by note taking and recording all sessions and online chat. A narrative summary of all sessions was produced and synthesised to identify points of agreement and aspects of methods where uncertainty remains. RESULTS There was broad agreement that DCE is working well as the principal valuation method. However, the most appropriate means of anchoring the latent scale values produced by DCE remains unclear. Some studies have deviated from the protocol by extending the number of states included in TTO tasks, to better support modelling of DCE and TTO. There is ongoing discussion about the relative merits of alternative variants of TTO and other methods for anchoring. Very few studies have consulted with local end-users to gauge the acceptability of methods used to value EQ-5D-Y. CONCLUSIONS Priority areas for research include testing alternative methods for anchoring DCE data; exploring the preferences of adolescents; and scale differences in values for EQ-5D-Y and adult EQ-5D states, and implications of such differences for the use of EQ-5D-Y values in HTA. Given the normative elements of the protocol, engaging with HTA bodies and other local users should be the first step for all future value set studies. Value sets undertaken to date are for the three-level EQ-5D-Y. However, the issues discussed in this paper are equally relevant to valuation of the five-level version of EQ-5D-Y; indeed, similar challenges are encountered valuing any measure of child HRQoL.
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Affiliation(s)
- N Devlin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Parkville, VIC, 3010, Australia. .,Office of Health Economics, London, UK.
| | - T Pan
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Parkville, VIC, 3010, Australia
| | - S Kreimeier
- Department of Health Economics and Health Care Management, Faculty of Health Science, Bielefeld University, Bielefeld, Germany
| | - J Verstraete
- Division of Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - E Stolk
- EuroQol Research Foundation, Rotterdam, Netherlands
| | - K Rand
- Health Services Research Centre, Akershus University Hospital, Nordbyhagen, Norway
| | - M Herdman
- Office of Health Economics, London, UK
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28
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Reckers-Droog V, Karimi M, Lipman S, Verstraete J. Why Do Adults Value EQ-5D-Y-3L Health States Differently for Themselves Than for Children and Adolescents: A Think-Aloud Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1174-1184. [PMID: 35168891 DOI: 10.1016/j.jval.2021.12.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Following protocol, adults value EQ-5D-Y-3L health states from the perspective of a 10-year-old child. It remains unclear why adults value health states differently for themselves than for a 10-year-old child and whether the latter perspective is representative of adults' preferences for the 8 to 15 years age range of the EQ-5D-Y-3L. This study examines the reasons underlying (potential) differences in adults' health-state preferences for themselves, a 10-year-old child, and 15-year-old adolescent. METHODS We conducted semistructured interviews using a think-aloud protocol with 25 participants who performed valuation tasks in July 2020 to August 2020. Using the Framework Method, we developed 28 categories grouped under 5 themes that illustrated the differences emerging from the interviews. RESULTS Participants (A) deemed it more straining to perform valuation tasks for a 10-year-old child and 15-year-old adolescent than for themselves, (B) had a stable self-image, but varied in whom they imagined as 10-year-old child and 15-year-old adolescent, (C) focused on different dimensions and levels for a 15-year-old adolescent than for a 10-year-old child and themselves, (D) had various thoughts about nonhealth-related factors that influenced their preferences, and (E) gave up relatively few life-years for a 10-year-old child and 15-year-old adolescent, also to avoid others bearing a grudge against them. CONCLUSIONS Our results indicate that differences in adults' health-state preferences for themselves and a 10-year-old child largely result from differences in thoughts about nonhealth-related factors. They further indicate that health-state preferences for a 10-year-old child may not be representative of such preferences for the full EQ-5D-Y-3L age range.
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Affiliation(s)
- Vivian Reckers-Droog
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Milad Karimi
- OPEN Health Evidence & Access, Rotterdam, The Netherlands
| | - Stefan Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Janine Verstraete
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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29
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Bailey C, Howell M, Raghunandan R, Salisbury A, Chen G, Coast J, Craig JC, Devlin NJ, Huynh E, Lancsar E, Mulhern BJ, Norman R, Petrou S, Ratcliffe J, Street DJ, Howard K, Viney R. Preference Elicitation Techniques Used in Valuing Children's Health-Related Quality-of-Life: A Systematic Review. PHARMACOECONOMICS 2022; 40:663-698. [PMID: 35619044 PMCID: PMC9270310 DOI: 10.1007/s40273-022-01149-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Valuing children's health states for use in economic evaluations is globally relevant and is of particular relevance in jurisdictions where a cost-utility analysis is the preferred form of analysis for decision making. Despite this, the challenges with valuing child health mean that there are many remaining questions for debate about the approach to elicitation of values. The aim of this paper was to identify and describe the methods used to value children's health states and the specific issues that arise in the use of these methods. METHODS We conducted a systematic search of electronic databases to identify studies published in English since 1990 that used preference elicitation methods to value child and adolescent (under 18 years of age) health states. Eligibility criteria comprised valuation studies concerning both child-specific patient-reported outcome measures and child health states defined in other ways, and methodological studies of valuation approaches that may or may not have yielded a value set algorithm. RESULTS A total of 77 eligible studies were identified from which data on country setting, aims, condition (general population or clinically specific), sample size, age of respondents, the perspective that participants were asked to adopt, source of values (respondents who completed the preference elicitation tasks) and methods questions asked were extracted. Extracted data were classified and evaluated using narrative synthesis methods. The studies were classified into three groups: (1) studies comparing elicitation methods (n = 30); (2) studies comparing perspectives (n = 23); and (3) studies where no comparisons were presented (n = 26); selected studies could fall into more than one group. Overall, the studies varied considerably both in methods used and in reporting. The preference elicitation tasks included time trade-off, standard gamble, visual analogue scaling, rating/ranking, discrete choice experiments, best-worst scaling and willingness to pay elicited through a contingent valuation. Perspectives included adults' considering the health states from their own perspective, adults taking the perspective of a child (own, other, hypothetical) and a child/adolescent taking their own or the perspective of another child. There was some evidence that children gave lower values for comparable health states than did adults that adopted their own perspective or adult/parents that adopted the perspective of children. CONCLUSIONS Differences in reporting limited the conclusions that can be formed about which methods are most suitable for eliciting preferences for children's health and the influence of differing perspectives and values. Difficulties encountered in drawing conclusions from the data (such as lack of consensus and poor reporting making it difficult for users to choose and interpret available values) suggest that reporting guidelines are required to improve the consistency and quality of reporting of studies that value children's health using preference-based techniques.
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Affiliation(s)
- Cate Bailey
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne, VIC, Australia.
| | - Martin Howell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rakhee Raghunandan
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amber Salisbury
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nancy J Devlin
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
| | - Elisabeth Huynh
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Lancsar
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Brendan J Mulhern
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deborah J Street
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rosalie Viney
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
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30
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Devlin NJ. Valuing Child Health Isn't Child's Play. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1087-1089. [PMID: 35667949 DOI: 10.1016/j.jval.2022.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 05/20/2023]
Affiliation(s)
- Nancy J Devlin
- Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia.
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31
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Dewilde S, Janssen MF, Lloyd AJ, Shah K. Exploration of the Reasons Why Health State Valuation Differs for Children Compared With Adults: A Mixed Methods Approach. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1185-1195. [PMID: 35232661 DOI: 10.1016/j.jval.2021.11.1377] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/18/2021] [Accepted: 11/19/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Evidence comparing utilities for adults and children consistently report higher utility values for child health states. This study investigates the reasons why child health states are valued differently. METHODS A total of 80 respondents (United Kingdom, Belgium, The Netherlands) participated in 1.5-hour face-to-face interviews. Respondents valued 4 health states from 2 perspectives (8-year-old child, 40-year-old adult) using visual analog scale and time trade-off. A total of 32 respondents participated in think-aloud interviews. Audio recordings were analyzed by 2 independent coders using NVIVO software. Statements, nodes, and themes were reviewed cyclically until consensus was reached. RESULTS Qualitative results: a total of 5 themes were identified in the data regarding child and adult valuation-intergenerational responsibility and dependency (childhood is crucial for forming life skills based on new experiences; adulthood is an important time to take care of the family), staying alive is important (life is worth living even with impaired health-related quality of life (HRQoL), for children and adults), awareness of poor HRQoL and ability to make decisions (children have difficulties comprehending poor HRQoL and their parents make their healthcare decision; adults can assess their own HRQoL and decide for themselves), coping ability (children are flexible and resilient; adults have experience with dealing with difficulties), and practical organization of care (children are cared for by their parents; adults are able to organize and pay for care). Mixed methods: comparing qualitative statements with respondents' higher utilities for child health states confirmed concordance between results. CONCLUSIONS Quality-adjusted life-years are interpreted differently for children and adults. Child-specific value sets are needed to reflect society's preferences and to adequately conduct health technology assessment of pediatric treatments.
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Affiliation(s)
- Sarah Dewilde
- Services in Health Economics SHE, Brussels, Belgium.
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | | | - Koonal Shah
- Science Policy and Research Programme, National Institute for Health and Care Excellence, London, England, UK
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Ramos-Goñi JM, Estévez-Carrillo A, Rivero-Arias O, Rowen D, Mott D, Shah K, Oppe M. Does Changing the Age of a Child to be Considered in 3-Level Version of EQ-5D-Y Discrete Choice Experiment-Based Valuation Studies Affect Health Preferences? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1196-1204. [PMID: 35379562 DOI: 10.1016/j.jval.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/22/2021] [Accepted: 03/02/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVES There has been some debate about the choice of perspective and the age of the child considered when completing preference elicitation tasks in the 3-level version of EQ-5D-Y (EQ-5D-Y-3L) valuation protocol. This study aimed to clarify the impact on latent scale EQ-5D-Y-3L values of varying the age of the child experiencing the health state considered by respondents completing the discrete choice experiment (DCE) tasks of the protocol. METHODS We conducted an online DCE with a representative sample of 1000 adults in the United Kingdom and 1000 adults in the United States. Respondents selected the health state they prefer from a series of DCE paired EQ-5D-Y-3L health state comparisons using their own perspective and that of a hypothetical child from the following age groups: "5-7 years old," "8-10 years old," "11-13 years old," and "14-15 years old." Data analysis was conducted using separate multinomial logit models for each perspective and country. We also estimated combined models including data from each possible pair of perspectives and used interactions between EQ-5D-Y-3L levels and perspective to determine whether any differences were statistically significant. RESULTS No statistically significant differences in coefficients between perspectives were found in the United States. In the United Kingdom, there were differences between the own perspective and the 5 to 7 years old perspective (looking after myself level 3) and between the 5 to 7 years old perspective and the 8 to 10 years old perspective (usual activities level 3). CONCLUSIONS Our results suggest that there is minimal impact on latent scale values when using different ages of the hypothetical child in the current EQ-5D-Y-3L valuation protocol.
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Affiliation(s)
| | | | - Oliver Rivero-Arias
- Maths in Health, Rotterdam, The Netherlands; National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - David Mott
- Office of Health Economics, London, England, UK
| | - Koonal Shah
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK; PHMR, London, England, UK; National Institute for Health and Care Excellence, London, England, UK
| | - Mark Oppe
- Maths in Health, Rotterdam, The Netherlands
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Rowen D, Mukuria C, Powell PA, Wailoo A. Exploring the Issues of Valuing Child and Adolescent Health States Using a Mixed Sample of Adolescents and Adults. PHARMACOECONOMICS 2022; 40:479-488. [PMID: 35292942 DOI: 10.1007/s40273-022-01133-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Preferences for child and adolescent health states used to generate health state utility values can be elicited from adults, young adults, adolescents, or combinations of these. This commentary paper provides a critical overview of issues and implications arising from valuing child and adolescent health states using a novel approach of a mixed sample of adolescents and adults. The commentary is informed by critical analysis of normative, ethical, practical and theoretical arguments in the health state valuation literature. Discussion focusses upon adolescent empowerment, understanding and psychosocial maturity; ethical concerns; elicitation tasks; perspective; and selection of sample proportions across adolescents and adults. It is argued that valuation of child and adolescent health states by both adolescents and adults could involve all participants completing the same preference elicitation task using the same perspective (e.g. time trade-off imagining they are living in the health state), and all preferences being modelled to generate a combined value set that reflects both adolescent and adult preferences. It is concluded that the valuation of child and adolescent health states by a mixed adolescent and adult sample appears feasible and has the advantage that it includes some of the population who can potentially experience the health states, thus enabling adolescents to express their views around matters that may affect them, and the population that are taxpayers and voters. However, both the relative proportion of adults and adolescents to include in a valuation sample and the elicitation technique require careful consideration.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK.
| | - Clara Mukuria
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK
| | - Philip A Powell
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, S1 4DA, UK
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Ramos-Goñi JM, Oppe M, Estévez-Carrillo A, Rivero-Arias O. Accounting for Unobservable Preference Heterogeneity and Evaluating Alternative Anchoring Approaches to Estimate Country-Specific EQ-5D-Y Value Sets: A Case Study Using Spanish Preference Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:835-843. [PMID: 35500952 DOI: 10.1016/j.jval.2021.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES The EuroQol Group published the EQ-5D-Y valuation protocol that recommends 2 valuation techniques to elicit preferences: composite time trade-off (C-TTO) and discrete choice experiments (DCEs). The protocol left the decision of what modeling approach to use open for researchers. Our aims were to explore modeling strategies allowing generation of EQ-5D-Y value sets and to produce an EQ-5D-Y Spanish value set. METHODS We used EQ-5D-Y DCE and C-TTO data collected in Spain following the protocol and adopted a staged approach for our modeling exercise. First, we selected the best performing DCE latent class model and evaluated models from 2 to 10 classes. We selected the preferred model based on best goodness of fit in terms of the Bayesian information criterion. We considered 2 anchoring approaches to estimate utility values: (1) pits state anchoring and (2) hybrid models (using all available C-TTO responses). All analysis were weighted to be representative of the Spanish population. RESULTS We collected 1005 DCE and 200 C-TTO interviews. We selected a DCE model including 4 classes. Hybrid models using all available C-TTO observations produced a narrower range of values than the pits state anchoring approach. CONCLUSIONS In this article, we have presented an EQ-5D-Y value set that can be used for cost-utility analysis in Spain. The international EQ-5D-Y valuation protocol should be updated to include a different set of health states for the C-TTO experiment if researchers wish to use alternative anchoring approaches to the "pits state."
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Affiliation(s)
- Juan M Ramos-Goñi
- Maths in Health, Rotterdam, the Netherlands; Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Mark Oppe
- Maths in Health, Rotterdam, the Netherlands
| | | | - Oliver Rivero-Arias
- Maths in Health, Rotterdam, the Netherlands; National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
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Åström M, Rolfson O, Burström K. Exploring EQ-5D-Y-3L Experience-Based VAS Values Derived Among Adolescents. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:383-393. [PMID: 35083734 PMCID: PMC9021108 DOI: 10.1007/s40258-021-00713-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The EQ-5D-Y-3L is a generic health-related quality of life (HRQoL) instrument, developed from the adult version to be suitable for children and adolescents aged 8-15 years. To derive values for the EQ-5D-Y-3L different valuation methods and perspectives have been applied. The aim of this study was to explore EQ-5D-Y-3L experience-based visual analogue scale (VAS) values derived among adolescents. METHODS Data were derived from a cross-sectional population survey administered via schools in 2014 to adolescents aged 13-18 years, in Sweden. Regression analyses were performed on individual data with the VAS value as dependent variable. Ordinary least-squares (OLS) and generalised linear models (GLM) were estimated with two dummy variables for each of the EQ-5D-Y-3L dimensions. Interaction variables were tested. One way of anchoring VAS at dead and full health by using the predicted values for worst and best health states defined by the EQ-5D-Y-3L descriptive system was explored. RESULTS Of the 243 possible health states in EQ-5D-Y-3L, 92 were reported by the 6,468 respondents. The largest decrements in VAS values were observed for the dimension 'feeling worried, sad or unhappy' followed by 'doing usual activities'. All models performed similarly in terms of monotonicity and goodness of fit but in terms of simplicity and understandability, the OLS main effect model was superior. CONCLUSIONS We have explored experience-based VAS values for the EQ-5D-Y-3L derived among adolescents. The findings suggest that it is possible for adolescents to value their own health state using the VAS, which makes it possible to capture aspects that are important for young people.
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Affiliation(s)
- Mimmi Åström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden.
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Schneider P. The QALY is ableist: on the unethical implications of health states worse than dead. Qual Life Res 2022; 31:1545-1552. [PMID: 34882282 PMCID: PMC9023412 DOI: 10.1007/s11136-021-03052-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A long-standing criticism of the QALY has been that it would discriminate against people in poor health: extending the lives of individuals with underlying health conditions gains fewer QALYs than extending the lives of 'more healthy' individuals. Proponents of the QALY counter that this only reflects the general public's preferences and constitutes an efficient allocation of resources. A pivotal issue that has thus far been overlooked is that there can also be negative QALYs. METHODS AND RESULTS Negative QALYs are assigned to the times spent in any health state that is considered to be worse than dead. In a health economic evaluation, extending the lives of people who live in such states reduces the overall population health; it counts as a loss. The problem with this assessment is that the QALY is not based on the perspectives of individual patients-who usually consider their lives to be well worth living-but it reflects the preferences of the general public. While it may be generally legitimate to use those preferences to inform decisions about the allocation of health care resources, when it comes to states worse than dead, the implications are deeply problematic. In this paper, I discuss the (un)ethical aspects of states worse than dead and demonstrate how their use in economic evaluation leads to a systematic underestimation of the value of life-extending treatments. CONCLUSION States worse than dead should thus no longer be used, and a non-negative value should be placed on all human lives.
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Affiliation(s)
- Paul Schneider
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
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Rombach I, Wang K, Tonner S, Grabey J, Harnden A, Wolstenholme J. Quality of life, healthcare use and costs in 'at-risk' children after early antibiotic treatment versus placebo for influenza-like illness: within-trial descriptive economic analyses of the ARCHIE randomised controlled trial. BMJ Open 2022; 12:e049373. [PMID: 35428613 PMCID: PMC9014043 DOI: 10.1136/bmjopen-2021-049373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To characterise the quality of life, healthcare use and costs associated with early antibiotic treatment of influenza-like illness (ILI) in 'at-risk' children. DESIGN Economic analysis of a two-arm double-blind parallel group pragmatic randomised controlled trial. SETTING Children were recruited from community-based healthcare settings, including general practices, walk-in centres and hospital ambulatory care. PARTICIPANTS Children with risk factors for influenza-related complications, including respiratory, cardiac and neurological conditions, who presented within the first 5 days of an ILI. INTERVENTIONS Co-amoxiclav 400/57 suspension or placebo. OUTCOME MEASURES This economic analysis focused on quality of life measured by the EQ-5D-Y, symptoms assessed by the Canadian Acute Respiratory Infection and Flu Scale (CARIFS), healthcare use and costs including medication, hospital visits and admissions, general practitioner and nurse contacts. Outcomes were assessed for up to 28 days post randomisation. RESULTS Information on resource use, EQ-5D-Y (day 28) and CARIFS (day 7) was available for 265 (98%), 72 (27%) and 123 (45%) out of 271 participants, respectively. Average costs in the co-amoxiclav group were £25 lower (95% CI -£113 to £65), but this difference was not statistically significant (p=0.566). The difference in EQ-5D-Y scores between groups was also not statistically significant (-0.014 (95% CI -0.124 to 0.096), p=0.798). However, day 7 CARIFS scores were 3.5 points lower in the co-amoxiclav arm (95% CI -6.9 to -0.1, p=0.044). CONCLUSIONS Our findings did not show evidence that early co-amoxiclav treatment improves quality of life or reduces healthcare use and costs in 'at-risk' children with ILI, but may reduce symptom severity though confirmation from further research would be important. Reliable data collection from children's parents/carers was challenging, and resulted in high levels of missing data, which is common in pragmatic trials involving children with acute respiratory tract infections. TRIAL REGISTRATION NUMBER ISRCTN70714783; EudraCT 2013-002822-21.
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Affiliation(s)
- Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sharon Tonner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jenna Grabey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Chimento-Díaz S, Sánchez-García P, Franco-Antonio C, Santano-Mogena E, Espino-Tato I, Cordovilla-Guardia S. Factors Associated with the Acceptance of New Technologies for Ageing in Place by People over 64 Years of Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052947. [PMID: 35270640 PMCID: PMC8910177 DOI: 10.3390/ijerph19052947] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Background: In the context of growing population ageing, technologies aimed at helping people age in place play a fundamental role. Acceptance of the implementation of technological solutions can be defined as the intention to use a technology or the effective use of it. Approaches based on the technology acceptance model (TAM) have been shown to have good predictive power for pre-implementation attitudes towards new technologies. Objective: To analyze the degree of acceptability of the use of new technologies for ageing in place and the factors associated with greater acceptance in people older than 64 years. Methodology: A descriptive cross-sectional study was carried out. Sociodemographic, clinical and environmental variables, architectural barriers, social risk and quality of life, degree of autonomy, morbidity, and risk of falls were collected in a population sample over 64 years of age in a large region of western Spain. The degree of acceptance of the use of technologies was measured through a scale based on the TAM. Results: Of the 293 people included in the study, 36.2% exhibited a high acceptability of new technologies, 28.3% exhibited a medium acceptability, and 35.5% exhibited a low acceptability. Of all the factors, age, education level, and living alone were significantly associated with high acceptance in the adjusted analyses. Conclusions: Younger age, a higher education level, and living alone are factors associated with a greater degree of acceptance of the use of technologies for ageing in place.
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Affiliation(s)
- Sara Chimento-Díaz
- Department of Computer and Telematic Systems Engineering, Polytechnic School of Cáceres, University of Extremadura, 10003 Cáceres, Spain; (S.C.-D.); (I.E.-T.)
- Health and Care Research Group (GISyC), University of Extremadura, 10003 Cáceres, Spain; (P.S.-G.); (E.S.-M.); (S.C.-G.)
| | - Pablo Sánchez-García
- Health and Care Research Group (GISyC), University of Extremadura, 10003 Cáceres, Spain; (P.S.-G.); (E.S.-M.); (S.C.-G.)
- Department of Medical-Surgical Therapy, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
| | - Cristina Franco-Antonio
- Health and Care Research Group (GISyC), University of Extremadura, 10003 Cáceres, Spain; (P.S.-G.); (E.S.-M.); (S.C.-G.)
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
- Correspondence:
| | - Esperanza Santano-Mogena
- Health and Care Research Group (GISyC), University of Extremadura, 10003 Cáceres, Spain; (P.S.-G.); (E.S.-M.); (S.C.-G.)
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
| | - Isabel Espino-Tato
- Department of Computer and Telematic Systems Engineering, Polytechnic School of Cáceres, University of Extremadura, 10003 Cáceres, Spain; (S.C.-D.); (I.E.-T.)
| | - Sergio Cordovilla-Guardia
- Health and Care Research Group (GISyC), University of Extremadura, 10003 Cáceres, Spain; (P.S.-G.); (E.S.-M.); (S.C.-G.)
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain
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Åström M, Conte H, Berg J, Burström K. 'Like holding the axe on who should live or not': adolescents' and adults' perceptions of valuing children's health states using a standardised valuation protocol for the EQ-5D-Y-3L. Qual Life Res 2022; 31:2133-2142. [PMID: 35201557 PMCID: PMC9188517 DOI: 10.1007/s11136-022-03107-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 02/07/2023]
Abstract
Purpose There is an increasing interest for using qualitative methods to investigate peoples’ cognitive process when asked to value health states. A standardised valuation protocol for the EQ-5D-Y-3L instrument was recently developed. Little is known regarding how people think, reason, and feel when asked to value health states for children. The aim was to explore how adolescents and adults perceive the task of valuing children’s health states using the standardised valuation protocol. Methods This was a qualitative study where adults (n = 10) and adolescents (n = 10) from the general population participated in individual video-interviews. Initially, participants reported their own health with the EQ-5D-3L instrument. Then they were asked to complete several valuations tasks for a 10-year-old child according to the standardised valuation protocol, followed by a semi-structured interview with open-ended questions to further explore participants’ perceptions. A qualitative content analysis was performed. Results The two main categories that emerged from the data were ‘Thoughts and feelings when valuing children’s health states’ and ‘Strategies when valuing children’s health states’. Participants expressed feeling doubt, awfulness and being reluctant to trade-off life years, and questioned who has the right to value health states for children. Experience and point of view were strategies participants used to complete the valuation tasks. Conclusion The findings from the present study can contribute to the understanding and interpretation of quantitative results where the standardised valuation protocol has been used to derive values for the EQ-5D-Y-3L. Furthermore, results of the study support the feasibility of including adolescents in valuation studies. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03107-0.
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Affiliation(s)
- Mimmi Åström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden. .,Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. .,Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Helen Conte
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Berg
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Dülsen P, Barck K, Daubmann A, Höller A, Zeidler J, Kilian R, Wiegand-Grefe S, Baumeister H. Clinical- and Cost Effectiveness of a Guided Internet-Based Intervention for Children (12–18 Years) of Parents With Mental Disorders (iCHIMPS): Study Protocol of a Multicentered Cluster-Randomized Controlled Trial. Front Digit Health 2022; 4:816412. [PMID: 35252960 PMCID: PMC8888925 DOI: 10.3389/fdgth.2022.816412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionChildren of parents with mental disorders have a high chance of developing a mental disorder themselves. However, this at-risk group is regularly overlooked and typically not seen by any mental health professionals. Internet- and mobile-based interventions (IMIs) can provide a means of promoting mental health for children of parents with mental disorders.ObjectiveThe introduced study will evaluate the clinical- and cost-effectiveness of the iCHIMPS IMI in promoting mental health for children of parents with mental disorders.MethodsA two-armed multicentered cluster-randomized controlled trial (cRCT) comparing the clinical- and cost-effectiveness of the iCHIMPS IMI in the intervention group (IG) to a treatment-as-usual (TAU) control group will be conducted. Recruitment will be handled at currently 21 adult mental health clinics throughout Germany. Participating families will be randomly divided into the two groups until the final sample size of 306 participating adolescents (age 12–18) has been reached. The adolescents in the intervention group will receive access to the IMI and can take part in up to eight intervention modules. Assessment will be conducted during the recruitment (baseline), 1-month, 2-months, and 6-month post-inclusion. Primary outcome is the mental health of the participating adolescents at 6-months post-inclusion as measured by the Youth Self Report score. Secondary self-report outcomes are mental wellbeing, self-efficacy, coping strategies and negative effects as well as mental health of the adolescents as reported by their parent(s). Included moderators are sociodemographic characteristics, working alliance, social support and the mental health diagnoses of the parents. Statistical analyses will be conducted on the intention-to-treat principle as well as with additional per-protocol analyses. Additionally, the cost-effectiveness as well as qualitative data concerning the adherence, acceptance, and feasibility of the IMI will be analyzed.DiscussionThe iCHIMPS cRCT examines the clinical- as well as cost-effectiveness of the iCHIMPS mental health promotion IMI for children of parents with mental disorders. This provides the opportunity to gain insights into an innovative as well as time- and location-independent form of support for this often-overlooked at-risk group. Additionally, the larger CHIMPS-NET project allows comparisons between internet-based and face-to-face interventions for a similar target group.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: DRKS00025158.
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Affiliation(s)
- Patrick Dülsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
- *Correspondence: Patrick Dülsen
| | - Katja Barck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anne Daubmann
- Department of Medical Biometry, Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- Department of Medical Biometry, Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hanover, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, BKH Günzburg, Ulm University, Ulm, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Lipman SA. Expect Nothing: The (Lack of) Influence of Subjective Life Expectancy on Valuation of Child Health States. FRONTIERS IN HEALTH SERVICES 2022; 2:803109. [PMID: 36925864 PMCID: PMC10012738 DOI: 10.3389/frhs.2022.803109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022]
Abstract
Objective Earlier research has shown that individuals' subjective life expectancy (SLE) affects health state valuation with time trade-off (TTO). Individuals with longer expected life durations are less willing to trade-off life duration, which yields higher utilities. In this article, the influence of SLE is explored in the valuation of EQ-5D-Y-3L with a proxy perspective, i.e., adults' valuation of health states considering the life of a 10-year-old child. As SLE for children is likely higher, this might explain earlier findings suggesting that individuals are less willing to trade-off years of life for children than for adults. Methods A total of 197 respondents were recruited to take part in digital TTO interviews, facilitated by trained interviewers. TTO interviews were implemented in accordance with the recommended protocol for the valuation of EQ-5D-Y-3L. Respondents valued 10 EQ-5D-Y-3L health states for a 10-year-old child, after which they were asked to report how old they themselves expected to become and also how old they expected a 10-year-old child to become. Results Generally, adult respondents reported higher SLE for children than for themselves. Neither SLE was systematically associated with the willingness to trade lifetime or the number of life years traded off in TTO tasks. This null-result was substantiated by regression analyses per health state. Conclusion The results of this study suggest that individuals' expectations about longevity are not associated with EQ-5D-Y-3L valuation. This lack of association is in contrast to earlier work and might be explained by the psychological distance introduced with proxy perspective valuation, or by the methodological differences with earlier work.
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Affiliation(s)
- Stefan A Lipman
- Department of Health Economics, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Lipman SA, Reckers-Droog VT, Karimi M, Jakubczyk M, Attema AE. Self vs. other, child vs. adult. An experimental comparison of valuation perspectives for valuation of EQ-5D-Y-3L health states. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1507-1518. [PMID: 34611793 PMCID: PMC8492455 DOI: 10.1007/s10198-021-01377-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/31/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVES EQ-5D-Y-3L health states are valued by adults taking the perspective of a 10-year-old child. Compared to valuation of adult EQ-5D instruments, this entails two changes to the perspective: (i) child health states are valued instead of adult health states and: (ii) health states are valued for someone else instead of for oneself. Although earlier work has shown that these combined changes yield different values for child and adult health states that are otherwise equal, it currently remains unclear why. Hence, we aimed to disentangle the effects of both changes. METHODS A sample of 205 students (mean age: 19.48) was surveyed. Each respondent completed visual analogue scale (VAS) and time trade-off (TTO) tasks for five EQ-5D-Y-3L states, using four randomly ordered perspectives: (i) self-adult (themselves), (ii) other-adult (someone their age), (iii) self-child (themselves as a 10-year-old), (iv) other-child (a child of 10 years old). We compared how each perspective impacted outcomes, precision and quality of EQ-5D-Y-3L valuation. RESULTS Overall, differences between perspectives were consistent, with their direction being dependent on the health states and respondents. For VAS, the effect on outcomes of valuation depended on severity, but variance was higher in valuation with child perspectives. For TTO, we observed that EQ-5D-Y-3L states valued on behalf of others (i.e., children or adults) received higher valuations, but lower variances. CONCLUSION The use of a different perspective appears to yield systematic differences in EQ-5D-Y-3L valuation, with considerable heterogeneity between health states and respondents. This may explain mixed findings in earlier work.
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Affiliation(s)
- S A Lipman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - V T Reckers-Droog
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M Karimi
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Pharmerit, Rotterdam, The Netherlands
| | - M Jakubczyk
- SGH Warsaw School of Economics, Decision Analysis and Support Unit, Warsaw, Poland
| | - A E Attema
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Shiroiwa T, Fukuda T. EQ-5D-Y Population Norms for Japanese Children and Adolescents. PHARMACOECONOMICS 2021; 39:1299-1308. [PMID: 34292524 PMCID: PMC8516751 DOI: 10.1007/s40273-021-01063-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study was aimed at establishing population norms of EQ-5D-Y in Japan by a nationwide large sample survey. METHODS We performed a door-to-door survey by visiting the homes of children/adolescents aged 8-15 years selected by random sampling. The planned sample size was 3600 from 100 districts in Japan. Children/adolescents were asked to respond to the EQ-5D-Y instrument, and their parents, to background questions on themselves and their children. Summary statistics by age/sex were calculated to obtain the Japanese population norms. A multiple linear regression model was used to examine the relationships between the EQ-5D-Y index and their parents' demographic factors, the children/adolescents' diseases/symptoms and the family environment. RESULTS We collected 3636 responses from 100 districts. The overall EQ-5D-Y index values (all sexes, ages) ranged from 0.90 to 0.95. The percentage of respondents reporting full health ranged from 40 to 60%. In regard to the influence of the children/adolescents' diseases/symptoms on disutility, developmental disability showed the largest disutility values of 0.090. Sleeplessness and body pain were the symptoms that exerted the greatest influence on the EQ-5D-Y index; the effect sizes ranged from - 0.030 to - 0.098 for sleeplessness, and from - 0.023 to - 0.079 for body pain. The EQ-5D-Y index of children/adolescents with parents who reported severe stress was lower by 0.072 (p < 0.001), as compared with that of children/adolescents with parents reporting no stress. CONCLUSIONS Population norms of EQ-5D-Y were established for the first time. We also clarified the relationship between the EQ-5D-Y index value and the children/adolescents' diseases/symptoms and the family environment.
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Affiliation(s)
- Takeru Shiroiwa
- Center for Outcomes Research and Economic Evaluation for Health (C2H), National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Takashi Fukuda
- Center for Outcomes Research and Economic Evaluation for Health (C2H), National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
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Livanou M, Lane R. Assessing the Feasibility of a Multicenter Transition Intervention Model Across Adolescent Secure Services in England (MOVING FORWARD): Protocol for a Feasibility Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e29273. [PMID: 34677140 PMCID: PMC8571693 DOI: 10.2196/29273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young people moving from adolescent secure inpatient units to adult care in the United Kingdom have multiple and complex needs and are more likely to experience poor transition outcomes. Poorly managed transitions can lead to enduring use and dependency on mental health services. However, there is a lack of knowledge about the feasibility of transitional care models. OBJECTIVE This paper presents the protocol for a study that aims to test a feasibility cluster randomized controlled trial for young people transitioning from adolescent secure services to adult-oriented settings. The overarching aim of the MOVING FORWARD study is to provide a preliminary estimate of the effectiveness and cost-effectiveness of a new transition intervention model and to inform a future full-scale cluster randomized controlled trial. METHODS The design of the study is a 3-arm feasibility cluster randomized controlled trial comparing the MOVING FORWARD intervention against standard transition preparation conducted at 6 adolescent secure services, of which 4 units will receive the intervention and 2 will serve as controls. Eligible young people between 17-19 years, their parents/carers, and key workers will be invited to participate. Young people and parents/carers will be allocated to two conditions (young people alone and young people with a parent/carer) and will receive 4 transition preparation workshops across 6 months. Six adolescent secure hospitals will be randomly allocated, stratified by area and service type. Data will be collected at 3 time points: baseline (T0), 6-12 months postintervention (T1), and 18-24 months postbaseline (T2). Primary and secondary outcomes will be based on assessment measures and interviews conducted at T1 and T2. RESULTS A total of 13 young people and 17 staff members have contributed to the intervention design through online advisory groups on the design of the study and important themes for transition. We have also consulted members of the public (a steering group) including 2 young people who have transitioned to the community and 2 parents/carers. Common identified themes included appropriateness of module content and support during delayed transitions. The content of the intervention will be finalized during the first 6 months of the study. Participants will be recruited over the course of 6 months. An intraclass correlation coefficient will be calculated to inform the power of the sample size for a further large-scale trial. With a sample size of 50, we will be able to estimate a dropout rate of 80% (95% CI -11% to 11%). CONCLUSIONS This research will provide practitioners and policy makers with an evidence-based framework of how training and familiarization with the prospective transitions can yield positive outcomes. This study will test whether a psychosocial intervention can be implemented in adolescent secure hospitals. The results will identify barriers and facilitators to the proposed intervention and will enable services to reflect on the quality of transitional care delivery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/29273.
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Affiliation(s)
- Maria Livanou
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, Kingston Upon Thames, United Kingdom
| | - Rebecca Lane
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, Kingston Upon Thames, United Kingdom
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Powell PA, Rowen D, Rivero-Arias O, Tsuchiya A, Brazier JE. Valuing child and adolescent health: a qualitative study on different perspectives and priorities taken by the adult general public. Health Qual Life Outcomes 2021; 19:222. [PMID: 34556133 PMCID: PMC8461831 DOI: 10.1186/s12955-021-01858-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Quantitative health preference research has shown that different "perspectives", defined here as who is imagined to be experiencing particular health states, impact stated preferences. This qualitative project aimed to elucidate this phenomenon, within the context of adults' valuation of child and adolescent health states. METHODS Six focus groups with 30 members of the UK adult public were conducted between December 2019 and February 2020 and analysed using framework analysis. Each focus group had two stages. First, participants individually completed time trade-off tasks and a pairwise task (mirroring a discrete choice experiment without duration) for two EQ-5D-Y health states, assuming a series of perspectives: (a) themselves at current age; (b) another adult; (c) 10-year old child; (d) themselves as a 10-year old child. Second, a semi-structured discussion explored their responses. RESULTS Participants' views were often heterogeneous, with some common themes. Qualitatively, participants expressed a different willingness to trade-off life years for a 10-year old child versus themselves or another adult, and this differed by the health profile and child imagined. The same health states were often viewed as having a different impact on utility for a 10-year old child than adults. Imagining a 10-year old child is difficult and there is variation in who is imagined. Participants found answering based on their own-adult perspective most acceptable. There were no strong preferences for prioritising child health over working-age adults' health. CONCLUSIONS If an adult sample is used to value child- and adolescent-specific health states it is important to consider the perspective employed. Members of the adult public provide different responses when different perspectives are used due to differences in the perceived impact of the same health states. If adults are asked to imagine a child, we recommend that sampling is representative for parental status, since this can affect preferences.
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Affiliation(s)
- Philip A Powell
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Aki Tsuchiya
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
- Department of Economics, University of Sheffield, Sheffield, UK
| | - John E Brazier
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Prevolnik Rupel V, Ramos-Goñi JM, Ogorevc M, Kreimeier S, Ludwig K, Greiner W. Comparison of Adult and Adolescent Preferences Toward EQ-5D-Y-3L Health States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1350-1359. [PMID: 34452716 PMCID: PMC8404973 DOI: 10.1016/j.jval.2021.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The international EQ-5D-Y-3L valuation protocol suggests obtaining preferences for EQ-5D-Y-3L health states from a sample of the general adult population. There is discussion around involving children and adolescents in the processes of preference elicitation and decision making. The objective of this study was to compare the preferences for EQ-5D-Y-3L obtained from adolescents for themselves to those of adults considering a hypothetical 10-year-old child in Germany, Slovenia, and Spain. METHODS A sample of a minimum of 700 adolescents and 1000 adults in each country was recruited through online panels. An online discrete choice experiment was used to obtain health-state preferences. For the purposes of comparison, all coefficients were rescaled to a 1 (best) to 0 (worst) scale. The differences between preferences in both samples were analyzed via the relative attribute importance of health dimensions from the mixed logit models. RESULTS Statistically significant differences between the preferences for EQ-5D-Y-3L states given by the 2 samples were observed in all 3 countries. The overall relative attribute importance was similar between adolescents and adults; adolescents usually gave more importance to mobility and self-care, and less to anxiety/depression. The rank-order of the dimension levels between adults and adolescents differs in all 3 countries. CONCLUSIONS Preferences toward EQ-5D-Y-3L states differ if estimated by adults taking the perspective of a child or by the adolescents themselves. Although it seems possible to obtain adolescents' preferences for inclusion in EQ-5D-Y-3L value sets, the desirability and acceptance of their preferences by researchers and decision makers need to be explored further.
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Affiliation(s)
| | | | - Marko Ogorevc
- Institute for Economic Research, Ljubljana, Slovenia
| | - Simone Kreimeier
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kristina Ludwig
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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Mitchell PM, Husbands S, Byford S, Kinghorn P, Bailey C, Peters TJ, Coast J. Challenges in developing capability measures for children and young people for use in the economic evaluation of health and care interventions. HEALTH ECONOMICS 2021; 30:1990-2003. [PMID: 34036671 PMCID: PMC7614859 DOI: 10.1002/hec.4363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 05/26/2023]
Abstract
Methods for measuring outcomes suitable for economic evaluations of health and care interventions have primarily focused on adults. The validity of such methods for children and young people is questionable in areas including the outcome domains measured and how they are measured and valued, with most existing measures narrowly focusing on health. Novel methods for assessing benefits beyond health by focusing on a person's capability have also concentrated on adults to date. This paper aims to set out the rationale for capability measures in children and young people. It argues for the need to expand the evaluative space beyond health functioning towards broader capabilities, with children and young people playing an integral role in capability measure development. Drawing from existing literature, specific challenges related to the identification, measurement, and valuation of capabilities in children and young people are also discussed. Finally, the practical implications for conducting economic evaluation when measuring and valuing capabilities at different stages across the life-course are illustrated. We develop an alternative framework based on conceiving capabilities as evolving across the life-course. This framework may also be helpful in thinking about how to model health outcomes across the life-course.
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Affiliation(s)
- Paul Mark Mitchell
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Samantha Husbands
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Byford
- King's Health Economics (KHE), Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip Kinghorn
- Health Economics Unit (HEU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Chauhan AS, Kapoor I, Rana SK, Kumar D, Gupta M, John J, Kang G, Prinja S. Cost effectiveness of typhoid vaccination in India. Vaccine 2021; 39:4089-4098. [PMID: 34120765 PMCID: PMC8256879 DOI: 10.1016/j.vaccine.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION World Health Organization has prequalified the use of typhoid conjugate vaccine (TCV) in children over six months of age in typhoid endemic countries. We assessed the cost-effectiveness of introducing TCV separately for urban and rural areas of India. METHODS A decision analytic model was developed, using a societal perspective, to compare long-term costs and outcomes (3% discount rate) in a new-born cohort of 100,000 children immunized with or without TCV. Three vaccination scenarios were modelled, assuming the protective efficacy of TCV to last for 5, 10 and 15 years following immunization. Incidence of typhoid infection estimated under 'National Surveillance System for Enteric Fever' (NSSEFI)' was used. The prices of vaccine and cost of service delivery were included for vaccination arm. Both health system cost and out-of-pocket expenditures for treatment of typhoid illness and its complications was included. RESULTS TCV introduction in urban areas would result in prevention of 17% to 36% typhoid cases and deaths. With exclusion of indirect costs, the incremental cost per QALY gained was ₹ 151,346 (54,730-307,975), ₹ 61,710 (-5250 to 163,283) and ₹ 45,188 (-17,069 to 141,093) for scenario 1, 2 and 3 respectively. While, with inclusion of indirect costs, all 3 scenarios were cost saving. Further, in rural areas, TCV is estimated to reduce the typhoid cases and deaths by 19% to 36%, with ICER (incremental cost per QALY gained) ranging from ₹ 2340 (1316-4370) to ₹ 3574 (2057 - 6691) thousand (inclusive of indirect costs) among the 3 vaccination scenarios. CONCLUSION From a societal perspective, introduction of TCV is a cost saving strategy in urban India. Further, due to low incidence of typhoid infection, introduction of TCV is not cost-effective in rural settings of India.
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Affiliation(s)
- Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Isha Kapoor
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Dilesh Kumar
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore 632 002, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Lipman SA, Reckers-Droog VT, Kreimeier S. Think of the Children: A Discussion of the Rationale for and Implications of the Perspective Used for EQ-5D-Y Health State Valuation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:976-982. [PMID: 34243841 DOI: 10.1016/j.jval.2021.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVES The 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. METHODS This 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. RESULTS Although 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. CONCLUSIONS The 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.
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Affiliation(s)
- Stefan A Lipman
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands.
| | - Vivian T Reckers-Droog
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Simone Kreimeier
- Bielefeld University, School of Public Health, Department of Health Economics and Health Care Management, Bielefeld, Germany
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Prevolnik Rupel V, Ogorevc M. EQ-5D-Y Value Set for Slovenia. PHARMACOECONOMICS 2021; 39:463-471. [PMID: 33565048 PMCID: PMC8009800 DOI: 10.1007/s40273-020-00994-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND A value set for the EuroQoL 5-Dimensions (EQ-5D)-Y in Slovenia is not yet available, making the calculation of quality-adjusted life-years (QALYs) for children and adolescents using this generic instrument impossible. OBJECTIVE The main objective of our study was to obtain adult preferences towards EQ-5D-Y health states in Slovenia, following the EQ-5D-Y-3L international valuation protocol. The adults were asked to take the perspective of a hypothetical 10-year-old child. METHOD A sample of 1074 adults in Slovenia completed an online discrete-choice experiment (DCE) survey on EQ-5D-Y health states. The latent scale issue was addressed by obtaining the value of the anchor (33333) with 200 composite time trade-off (cTTO) interviews. A mixed (random coefficients) logit model was used to estimate the value set. RESULTS All the estimated coefficients of the mixed logit model were statistically significant at the 1% level and had an expected negative sign. The most important health dimension in EQ-5D-Y is pain/discomfort, followed by anxiety/depression, usual activities, and mobility, with self-care being the least important health dimension. CONCLUSIONS The study addresses an important research gap and presents the EQ-5D-Y value set for Slovenia. At the time of writing, no published value sets are available for the EQ-5D-Y-3L appropriate for use in QALY calculations, making this value set the first EQ-5D-Y value set in the world.
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Affiliation(s)
| | - Marko Ogorevc
- Institute for Economic Research, Kardeljeva ploščad 17, 1000, Ljubljana, Slovenia
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