Essers Brigitte, Wang Pei, Stolk Elly, Jonker Marcel F, Evers Silvia, Joore Manuela, Dirksen Carmen
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands.
Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands.
Front Psychol. 2023 Oct 3;14:1175402. doi: 10.3389/fpsyg.2023.1175402. eCollection 2023.
The primary aim was to explore the age dependency of health state values derived via trade-offs between health-related quality of life (HRQoL) and life years in a discrete choice experiment (DCE). The secondary aim was to explore if people weigh life years and HRQoL differently for children, adolescents, adults, and older adults.
Participants from the general population of the Netherlands and China first completed a series of choice tasks offering choices between two EQ-5D-Y states with a given lifespan. The choice model captured the value of a year in full health, disutility determined by EQ-5D-Y, and a discount rate. Next, they received a slightly different choice task, offering choices between two lives that differed in HRQoL and life expectancy but produced the same number of quality-adjusted life years (QALYs). Participants were randomly assigned to fill out the survey for three or four age frames: a hypothetical person of 10, 15, 40, and 70 years (the last one only applicable to China) to allow the age dependency of the responses to be explored.
A total of 1,234 Dutch and 1,818 Chinese people administered the survey. Controlling for time preferences, we found that the agreement of health state values for different age frames was generally stronger in the Netherlands than in China. We found no clear pattern of differences in the QALY composition in both samples. The probability distribution over response options varied most when levels for lifespan or severity were at the extremes of the spectrum.
CONCLUSION/DISCUSSION: The magnitude and direction of age effects on values seemed dimension- and country specific. In the Netherlands, we found a few differences in dimension-specific weights elicited for 10- and 15-year-olds compared to 40-year-olds, but the overall age dependency of values was limited. A stronger age dependency of values was observed in China, where values for 70-year-olds differed strongly from the values for other ages. The appropriateness of using existing values beyond the age range for which they were measured needs to be evaluated in the local context.
主要目的是在离散选择实验（DCE）中，探究通过权衡健康相关生活质量（HRQoL）和生命年数得出的健康状态值的年龄依赖性。次要目的是探究人们对于儿童、青少年、成年人和老年人在权衡生命年数和HRQoL时是否存在差异。
来自荷兰和中国普通人群的参与者首先完成一系列选择任务，即在两个具有给定寿命的EQ-5D-Y状态之间进行选择。选择模型涵盖了完全健康状态下一年的价值、由EQ-5D-Y决定的负效用以及贴现率。接下来，他们收到一个稍有不同的选择任务，即在两种HRQoL和预期寿命不同但质量调整生命年（QALY）数量相同的生活之间进行选择。参与者被随机分配填写针对三个或四个年龄组的调查问卷：假设的10岁、15岁、40岁和70岁人群（最后一个年龄组仅适用于中国），以便探究回答的年龄依赖性。
共有1234名荷兰人和1818名中国人参与了调查。在控制时间偏好的情况下，我们发现不同年龄组健康状态值的一致性在荷兰总体上比在中国更强。我们在两个样本中均未发现QALY构成存在明显差异模式。当寿命或严重程度处于范围的极端水平时，响应选项的概率分布变化最大。
结论/讨论：年龄对价值的影响程度和方向似乎因维度和国家而异。在荷兰，我们发现与40岁人群相比，10岁和15岁人群在维度特定权重方面存在一些差异，但价值的总体年龄依赖性有限。在中国观察到更强的价值年龄依赖性，70岁人群的价值与其他年龄人群的价值差异很大。在当地背景下，需要评估使用超出其测量年龄范围的现有价值的适用性。
