Measuring and Valuing Health for Children: A Series of Reviews to Inform Health Technology Assessment

OBJECTIVES: We conducted three literature reviews to provide an overview of the evidence landscape on: 1) the development, measurement, and valuation of generic preference-based instruments for children; 2) comparison of health state preferences between adults and children; 3) use of spillover effects for family health-related quality of life (HRQoL).

METHODS: For each review, we searched electronic databases and websites of health technology assessment (HTA) agencies and relevant organizations to identify original research and published guidance in this area. Pairs of reviewers independently screened publications for inclusion. Data were extracted using a form developed by the research team and narratively synthesized.

RESULTS: In the first review, we identified 15 generic preference-based instruments. All instruments were developed for specific age groups apart from the QWB-SA, HUI2, and HUI3, which can be used for both children and adults. Several instruments have a proxy version. Multiple value sets were identified for the EQ-5D-Y-3L, CHU-9D, AQoL-6D, HUI3, IQI and HUI2. In the second review, we identified four studies that quantitatively compared children and adults’ health state preferences. Children generally had lower utility scores. This may be attributed to the health state description (e.g., vignette, EQ-5D-Y-3L), perspective (e.g., self vs hypothetical child), method of preference elicitation (e.g., SG, DCE), or how children consider dimensions of HRQoL (e.g., placing more weight on mobility). In the third review, we found that most pediatric cost-utility analyses conducted from a societal perspective included family costs, but few incorporated spillover health effects. There was no consensus on how spillover effects should be measured and quantified.

CONCLUSIONS: Understanding the evidence landscape is critical to identify knowledge gaps and prioritize future research. Based on these findings, we provide recommendations to facilitate the measurement and valuation of child health in HTA.