Mott David J, Shah Koonal K, Ramos-Goñi Juan Manuel, Devlin Nancy J, Rivero-Arias Oliver
Office of Health Economics, London, UK.
PHMR, London, UK.
Med Decis Making. 2021 Jul;41(5):584-596. doi: 10.1177/0272989X21999607. Epub 2021 Mar 18.
An important question in the valuation of children's health is whether the preferences of younger individuals should be captured within value sets for measures that are aimed at them. This depends on whether younger individuals can complete valuation exercises and whether their preferences differ from those of adults. This study compared the preferences of adults and adolescents for EQ-5D-Y-3L health states using latent scale values elicited from a discrete choice experiment (DCE).
An online DCE survey, comprising 15 pairwise choices, was provided to samples of UK adults and adolescents (aged 11-17 y). Adults considered the health of a 10-year-old child, whereas adolescents considered their own health. Mixed logit models were estimated, and comparisons were made using relative attribute importance (RAI) scores and a pooled model.
In total, 1000 adults and 1005 adolescents completed the survey. For both samples, level 3 in pain/discomfort was most important, and level 2 in self-care the least important, based on the relative magnitudes of coefficients. The RAI scores (normalized on self-care) indicated that adolescents gave less weight relative to adults to usual activities (1.18 v. 1.51; < 0.05), pain/discomfort (1.77 v. 3.12; < 0.01), and anxiety/depression (1.64 vs. 2.65; < 0.01). The pooled model indicated evidence of differences between the two samples in both levels in pain/discomfort and anxiety/depression.
The perspective of the DCE task differed between the 2 samples, and no data were collected to anchor the DCE data to generate value sets.
Adolescents could complete the DCE, and their preferences differed from those of adults taking a child perspective. It is important to consider whether their preferences should be incorporated into value sets.
儿童健康评估中的一个重要问题是，针对儿童的健康指标的价值集是否应体现较年轻个体的偏好。这取决于较年轻个体是否能够完成评估活动，以及他们的偏好是否与成年人不同。本研究使用离散选择实验（DCE）得出的潜在量表值，比较了成年人与青少年对EQ-5D-Y-3L健康状态的偏好。
向英国成年人和青少年（11至17岁）样本提供了一项包含15对选择的在线DCE调查。成年人考虑的是一名10岁儿童的健康，而青少年考虑的是他们自己的健康。估计了混合逻辑模型，并使用相对属性重要性（RAI）得分和合并模型进行比较。
共有1000名成年人和1005名青少年完成了调查。基于系数的相对大小，对于两个样本而言，疼痛/不适维度的3级最为重要，自我护理维度的2级最不重要。RAI得分（以自我护理为基准进行标准化）表明，相对于成年人，青少年对日常活动（1.18对1.51；<0.05）、疼痛/不适（1.77对3.12；<0.01）和焦虑/抑郁（1.64对2.65；<0.01）的权重较低。合并模型表明，两个样本在疼痛/不适和焦虑/抑郁这两个维度的两个级别上均存在差异。
两个样本的DCE任务视角不同，且未收集数据来锚定DCE数据以生成价值集。
青少年能够完成DCE，且他们的偏好与从儿童视角考虑的成年人不同。考虑是否应将他们的偏好纳入价值集很重要。
