Brunner H I, Maker D, Grundland B, Young N L, Blanchette V, Stain A M, Feldman B M
William Rowe Division of Rheumatology, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Med Decis Making. 2003 Jul-Aug;23(4):314-22. doi: 10.1177/0272989X03256008.
Health-related quality of life can be measured by patients' health preferences (utilities or values). No method for measuring health state preferences has been standardized for children with arthritis or other musculoskeletal disorders (MSKDs). Such a method is needed for economic evaluations of current and new pediatric treatments.
Eighty parents of children with MSKDs were consecutively sampled. Their children, if 8 years of age or older (n = 55), were studied concurrently. Utilities of current health states were obtained by using the SG and the HUI in random order. In addition, health state preferences were assessed using categorical and analog rating scales. Traditional nonutility measures of health status (the Childhood Health Assessment Questionnaire [CHAQ] and the Activities Scale for Kids [ASK]) were also completed. Intraclass correlation coefficients (ICCs) were calculated to assess concordance between the different utility measures and also between the ratings of the parents and their children.
Children 8 years of age or older were able to express the strength of their health state preferences using the HUI and rating scales. Children older than 10 years of age were able to use the SG method. The health state utilities of the parents were higher than those of their children. The utilities varied widely depending on the elicitation method. The expected high agreement between the SG and the HUI was not found (ICC = 0.028 for parents, ICC = 0.016 for patients). Unlike the SG, the global utilities derived from the HUI agreed better with preferences derived from rating scales (ICC = 0.23-0.25) and correlated with traditional health status measures (with CHAQ, r = -0.56; with ASK, r = 0.46) both for parents and children. It was not possible to mathematically convert rating scale preferences into SG utilities. The SG utilities were unrelated to results from the rating scales, the CHAQ, and the ASK. Especially for parents, the SG utilities were very high, even when ratings of the other measures indicated poor health.
Although it is possible to measure health utilities for children with MSKDs, the results are highly method dependent. The properties of the HUI in this population are more like those of the traditional health status measures rather than those of the SG. Preferences derived from rating scales, although easily performed, cannot readily be converted into SG utilities. Parents' ratings for their children are impaired by risk aversion.
与健康相关的生活质量可以通过患者的健康偏好（效用或价值观）来衡量。对于患有关节炎或其他肌肉骨骼疾病（MSKDs）的儿童，尚无测量健康状态偏好的方法得到标准化。当前和新的儿科治疗的经济评估需要这样一种方法。
1）评估对患有MSKDs的儿童进行效用测量的可行性，2）测试健康效用指数（HUI）对这些儿童的有效性，3）评估评分量表值是否可以通过数学方法转换为有意义的标准博弈（SG）效用，4）研究父母在健康状态偏好方面是否可以作为其子女的代理人。
连续抽取80名患有MSKDs儿童的父母。他们8岁及以上的孩子（n = 55）同时参与研究。通过随机顺序使用SG和HUI来获取当前健康状态的效用。此外，使用分类和类比评分量表评估健康状态偏好。还完成了健康状况的传统非效用测量（儿童健康评估问卷[CHAQ]和儿童活动量表[ASK]）。计算组内相关系数（ICC）以评估不同效用测量之间以及父母与子女评分之间的一致性。
8岁及以上的儿童能够使用HUI和评分量表表达其健康状态偏好的强度。10岁以上的儿童能够使用SG方法。父母的健康状态效用高于其子女。效用因诱导方法而异。未发现SG和HUI之间预期的高度一致性（父母的ICC = 0.028，患者的ICC = 0.016）。与SG不同，从HUI得出的总体效用与从评分量表得出的偏好更一致（ICC = 0.23 - 0.25），并且与父母和子女的传统健康状况测量相关（与CHAQ，r = -0.56；与ASK，r = 0.46）。无法通过数学方法将评分量表偏好转换为SG效用。SG效用与评分量表、CHAQ和ASK的结果无关。特别是对于父母，即使其他测量的评分表明健康状况不佳，SG效用也非常高。
虽然可以测量患有MSKDs儿童的健康效用，但结果高度依赖方法。HUI在该人群中的特性更类似于传统健康状况测量的特性，而不是SG的特性。从评分量表得出的偏好虽然易于执行，但不能轻易转换为SG效用。父母对其子女的评分受到风险厌恶的影响。
