Estimating Preference-Based Health Utilities Index Mark 3 Utility Scores for Childhood Conditions in England and Scotland
ABSTRACT A common feature of studies that have compiled lists or catalogues of preference-based health-related quality-of-life weights for inclusion within quality-adjusted life years (QALYs) is their focus upon adult populations.More generally, utility measurement in or on behalf of children has been constrained by a number of methodological concerns.
To augment previous catalogues of preference-based health-related quality-of-life weights by estimating preference-based Health Utilities Index Mark 3 (HUI3) multiattribute utility scores associated with a wide range of childhood conditions.
Data for 2236 children from the "Disability Survey 2000: Survey of Young People With a Disability and Sport" formed the basis of this investigation. Ordinary least squares (OLS), Tobit, and censored least absolute deviations(CLAD) regression methods were used to estimate adjusted marginal disutilities for each condition from 2 thresholds: 1) a threshold of 1.0 representing perfect health and 2) a normative childhood utility threshold.
Prespecified statistical tests indicated a preference for the OLS regression model over the Tobit and CLAD models. The unadjusted mean, median, 25th percentile and 75th percentile HUI3 multiattribute utility scores and adjusted marginal disutilities are presented for 43 conditions. Notably, based on the OLS estimator, the adjusted marginal disutilities for hydrocephalus; learning and physical disabilities; other syndromes and associations; meningitis, encephalitis, and other infections of the central nervous system; and microcephaly were estimated at -0.889 (95% confidence interval [CI]: -0.727, -1.000), -0.858 (95% CI: -0.727, -0.989), -0.838 (95% CI: -0.668, -1.000), -0.826(95% CI: -0.677, -0.975), and -0.820 (95% CI: -0.670, -0.970), respectively, when a perfect health threshold was applied, and -0.814 (95% CI: -0.656, -0.979), -0.783 (95%CI: -0.656, -0.918), -0.763 (95% CI: -0.597, -0.937), -0.751 (95% CI: -0.606, -0.904), and -0.745 (95% CI: -0.598, -0.899), respectively, when a normative childhood utility threshold was applied.
Our estimates and their associated distributions can be used for the purposes of QALY estimation by analysts conducting economic evaluations within the childhood context.
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ABSTRACT: Background Children's and adolescent's speech and language difficulties (SaLD) can affect various domains of quality of life (QoL), and speech and language therapy interventions are critical to improving QoL. Systematically measuring QoL outcomes in this population is highly complex due to factors such as heterogeneity in impairments and differing targets during intervention. However, measurements of QoL are increasingly required by healthcare commissioners and policy-makers to inform resource allocation.AimsTo review the use of QoL measures in research involving children (age ≤ 18 years) with SaLD.Methods & ProceduresA systematic review was undertaken. A systematic search across various databases was performed. Information on the methodological details of each relevant study, along with descriptions of the QoL measures employed, were extracted into standardized data extraction forms. Findings were discussed in a narrative synthesis.Outcomes & ResultsTwenty-one relevant studies were identified that deal with a range of subpopulations of children with SaLD. For the most part, generic QoL measures were used, although there was little convergence on the type of QoL measures employed throughout the literature. Five studies utilized preference-based QoL measures, including the 16D/17D, HUI3, EQ-5D and QWB-SA. Of these measures, the HUI3 demonstrated the most promising discriminant validity, although the preference weights for this measure were generated with adults.Conclusions & ImplicationsQoL among children with SaLD is not yet being captured in a systematic way. The HUI3 measure appears to show some promise for generating relevant preference-based QoL estimates, although further testing of the measure is required.International Journal of Language & Communication Disorders 01/2015; DOI:10.1111/1460-6984.12147 · 1.39 Impact Factor
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ABSTRACT: Purpose: To derive utility values associated with the health of children with autism spectrum disorders (ASD) and their parents, and describe how these utility values vary across different severity levels of ASD. Methods: Parents of children with and without ASD were selected from a nationally representative research panel to complete an internet survey. All survey respondents answered a series of time trade-off (TTO) questions to value their own current health state and their child’s current health state. Respondents were also asked socio-demographic and health questions regarding themselves and their child. Parents of children with ASD were asked to report the severity of their child’s ASD symptoms. We calculated utility values from each TTO amount. Regression analyses estimated the change in child health utility associated with ASD diagnosis and increasing symptom severity. Separate regression analyses evaluated the change in parent health utility associated with having a child with ASD. These regression analyses controlled for respondent socio-demographic characteristics, child’s gender, age, insurance status and other non-ASD related illnesses, as well as the presence of other children in the household. Results: We received responses from 69% of parents. Nine percent of respondents were eliminated from the analysis sample due to missing or invalid responses, leaving a final analysis sample size of 255 (135 parents of children with ASD and 120 parents of children without ASD). In adjusted analyses, having any form of ASD was significantly associated with a 0.26 (95% CI: 0.16-0.36) decrease in child health utility, compared to children without ASD. Having a child with ASD was significantly associated with 0.07 (95% CI: 0.02-0.12) decrease in parent health utility, compared to parents of children without ASD. The highest severity level of ASD was significantly associated with a 0.31 (95% CI: 0.12-0. 52) reduction in child health utility and a 0.18 (95% CI: 0.06-0.32) reduction in parent health utility. Conclusions: ASD has a large impact on child health utility values, and this impact is influenced by the severity of the child’s symptoms. In addition, having a child with ASD is associated with a significant decrease in parent health utility.The 34th Annual Meeting of the Society for Medical Decision Making; 10/2012
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ABSTRACT: Few cost-utility studies of child and adolescent mental health services (CAMHS) use quality adjusted life years (a combination of utility weights and time in health state) as the outcome to enable comparison across disparate programs and modalities. Part of the solution to this problem involves embedding preference-based health-related quality of life (PBHRQOL) utility instruments, which generate utility weights, in clinical practice and research. The Child Health Utility (CHU9D) is a generic PBHRQOL instrument developed specifically for use in young people. The purpose of this study was to assess the suitability of the CHU9D as a routine outcome measure in CAMHS clinical practice. Two hundred caregivers of children receiving community mental health services completed the CHU9D alongside a standardised child and adolescent mental health measure (the Strengths and Difficulties Questionnaire - SDQ) during a telephone interview. We investigated face validity, practicality, internal consistency, and convergent validity of the CHU9D. In addition, we compared the utility weights obtained in this group with utility weights from other studies of child and adolescent mental health populations. Participants found the CHU9D easy and quick to complete. It demonstrated acceptable internal consistency, and correlated moderately with the SDQ. It was able to discriminate between children in the abnormal range and those in the non-clinical/borderline range as measured by the SDQ. Three CHU9D items without corollaries in the SDQ (sleep, schoolwork, daily routine) were found to be significant predictors of the SDQ total score and may be useful clinical metrics. The mean utility weight of this sample was comparable with clinical subsamples from other CHU9D studies, but was significantly higher than mean utility weights noted in other child and adolescent mental health samples. Initial validation suggests further investigation of the CHU9D as a routine outcome measure in CAMHS is warranted. Further investigation should explore test-retest reliability, sensitivity to change, concordance between caregiver and child-completed forms, and the calibration of the utility weights. Differences between utility weights generated by the CHU9D and other utility instruments in this population should be further examined by administering a range of PBHRQOL instruments concurrently in a mental health group.Health and Quality of Life Outcomes 12/2015; 13(22). DOI:10.1186/s12955-015-0218-4 · 2.10 Impact Factor