Economic evaluations of interventions that target or include children require health state utilities (HSUs). Despite the availability of preference-weighted measures for children, methods for valuing child health states and estimating child utilities are not as well established as those for adult HSUs. The objective of this task force was to develop emerging good practice recommendations for valuing child and adolescent health to generate HSUs for use in economic evaluation. This task force identified and described the interrelated methodological choices regarding the valuation of child health to generate HSUs. The task force considered available evidence related to 4 key issues: (1) whose preferences should be sought, (2) whose health is imagined, (3) which method should be used, and (4) the comparability between adult and child utilities. Best practices may vary depending on the modeling context, characteristics of the health states, and the health technology assessment setting in which the HSUs will be used. For any individual study, methods will be informed by empirical evidence, value judgments, and recommendations from healthcare decision makers. Rather than recommending an approach that would apply to every study, this task force presents options to consider when determining the preference elicitation approach to generate utilities for child health states, along with the strengths and limitations of each. Given that child HSUs can affect the outcomes of a cost-utility analysis and subsequent decisions about healthcare resource allocation, this task force recommends that researchers be transparent about methodological choices and their impact on HSUs.

What is it about? Health state utilities are values needed to represent health-related quality of life in economic evaluations of healthcare interventions, including those targeting treatments for children. Although methods for eliciting preferences for adult health states are well established, valuing child health states is more challenging. This task force aimed to develop recommendations for valuing child health states to generate utilities for use in economic evaluation.

How was the Task Force conducted? The task force, which consisted of an international team including experts from academia, industry, consulting, and health technology assessment agencies, used a collaborative expert consensus process following ISPOR's established methods for developing Good Practices Reports. They identified and evaluated various options for generating child health state utilities while considering 4 key methodological issues: (1) whose preferences should be sought, (2) whose health should be imagined in health states, (3) which elicitation methods should be used to value health states, and (4) comparability between child and adult utilities. The task force focused primarily on methods for health states of children aged 5 years and older, though the recommendations are not necessarily restricted to this age group.

What were the recommendations? Based on the review of available evidence across the 4 areas described above, the authors provided a range of recommendations and suggestions. Methodological decisions across the first 3 issues (whose preferences, whose health is imagined, which method to use) cannot be made in isolation. They are interlinked and must be considered jointly. While specific recommendations are provided in each of these 3 areas, the task force does not prescribe a single optimal approach for valuing child health.  Instead, the authors acknowledge that appropriate methods will vary by modeling context, health state characteristics, health technology assessment jurisdiction, and value judgments that differ across countries. The task force encourages researchers to be transparent when reporting and justifying specific methods for any individual study. In addition, the task force suggests that health technology assessment bodies consider the methodological choices described in the report and provide guidance or normative judgments on these issues where appropriate.

Why are the recommendations important? The task force recommendations are important because the methodological choices made when generating child health state utilities can substantially impact the resulting utility values. Even small differences in utilities can affect the outcomes of cost-utility analyses, and results of these analyses often shape healthcare resource allocation decisions. With this report, researchers designing preference elicitation studies for child health states now have a framework to guide their methodological decisions, helping them make more informed study design choices. Healthcare decision makers may benefit from this report by gaining a better understanding of how study methods affect child health state utilities, enabling more informed interpretation of economic evaluations of treatments for children.

What are the strengths and limitations of this task force report? A strength of this report is its concise presentation of the complex methodological issues involved in valuing child health states, providing guidance where appropriate. A limitation of this field is that definitive recommendations cannot be provided that would apply across all situations, leaving researchers to make context-specific decisions.

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