Centre for Clinical Change, Flinders University, Adelaide, South Australia, Australia.
Appl Health Econ Health Policy. 2011;9(1):15-27. doi: 10.2165/11536960-000000000-00000.
QALYs are increasingly being utilized as a health outcome measure to calculate the benefits of new treatments and interventions within cost-utility analyses for economic evaluation. Cost-utility analyses of adolescent-specific treatment programmes are scant in comparison with those reported upon for adults and tend to incorporate the views of clinicians or adults as the main source of preferences. However, it is not clear that the views of adults are in accordance with those of adolescents on this issue. Hence, the treatments and interventions most highly valued by adults may not correspond with those most highly valued by adolescents. Ordinal methods for health state valuation may be more easily understood and interpreted by young adolescent samples than conventional approaches. The availability of young adolescent-specific health state values for the estimation of QALYs will provide new insights into the types of treatment programmes and health services that are most highly valued by young adolescents. The first objective of this study was to assess the feasibility of applying best-worst scaling (BWS) discrete-choice experiment (DCE) methods in a young adolescent sample to value health states defined by the Child Health Utility 9D (CHU9D) instrument, a new generic preference-based measure of health-related quality of life developed specifically for application in young people. The second objective was to compare BWS DCE questions (where respondents are asked to indicate the best and worst attribute for each of a number of health states, presented one at a time) with conventional time trade-off (TTO) and standard gamble (SG) questions in terms of ease of understanding and completeness. A feasibility study sample of consenting young adolescent school children (n = 16) aged 11-13 years participated in a face-to-face interview in which they were asked to indicate the best and worst attribute levels from a series of health states defined by the CHU9D, presented one at a time. Participants were also randomly allocated to receive additional conventional TTO or SG questions and prompted to indicate how difficult they found them to complete. The results indicate that participants were able to readily choose 'best' and 'worst' dimension levels in each of the CHU9D health states presented to them and provide justification for their choices. Furthermore, when presented with TTO or SG questions and prompted to make comparisons, participants found the BWS DCE task easier to understand and complete. The results of this feasibility study suggest that BWS DCE methods are potentially more readily understood and interpretable by vulnerable populations (e.g. young adolescents). These findings lend support to the potential application of BWS DCE methods to undertake large-scale health state valuation studies directly with young adolescent population samples.
质量调整生命年（QALYs）越来越多地被用作衡量健康结果的指标，用于在成本效用分析中计算新治疗方法和干预措施的收益，以进行经济评估。与针对成年人的研究相比，针对青少年特定治疗方案的成本效用分析很少，并且往往将临床医生或成年人的观点作为偏好的主要来源。然而，成年人的观点是否与青少年在这个问题上的观点相符并不清楚。因此，成年人最看重的治疗方法和干预措施可能与青少年最看重的方法和干预措施不一致。有序方法进行健康状态评估可能更容易被青少年样本理解和解释，而不是传统方法。青少年特定健康状态值的可用性可用于估计 QALYs，从而为青少年最看重的治疗方案和卫生服务类型提供新的见解。这项研究的第一个目标是评估在青少年样本中应用最佳最差标度（BWS）离散选择实验（DCE）方法的可行性，以对儿童健康效用 9D（CHU9D）工具定义的健康状态进行估值，这是一种新的通用偏好健康相关生活质量衡量标准，专门用于在年轻人中应用。第二个目标是比较 BWS DCE 问题（要求受访者为每次呈现的一系列健康状态中的每个状态指出最佳和最差属性）与传统时间权衡（TTO）和标准博弈（SG）问题在理解和完整性方面的难易程度。同意参加的青少年学校儿童（n=16）的可行性研究样本年龄在 11-13 岁之间，他们参加了面对面的访谈，在访谈中，他们被要求从 CHU9D 定义的一系列健康状态中指出最佳和最差属性水平，每次呈现一个状态。参与者还被随机分配接受额外的传统 TTO 或 SG 问题，并被要求指出他们认为完成这些问题的难度。结果表明，参与者能够轻松地为呈现给他们的每个 CHU9D 健康状态选择“最佳”和“最差”维度水平，并为他们的选择提供理由。此外，当参与者被要求完成 TTO 或 SG 问题并进行比较时，他们发现 BWS DCE 任务更容易理解和完成。这项可行性研究的结果表明，BWS DCE 方法可能更容易被弱势群体（例如青少年）理解和解释。这些发现支持在大规模健康状态估值研究中直接使用青少年群体样本应用 BWS DCE 方法的潜力。
