Slides from a presentation OHE's Koonal Shah gave at the PROMs research conference on June 20th, 2018. The subject of the presentation was valuing the EQ-5D-Y using a discrete choice experiment: do adult and adolescent preferences differ?

1. Koonal Shah, Office of Health Economics
PROMs Research Conference
University of Birmingham  20 June 2018
Valuing the EQ-5D-Y using a discrete
choice experiment: do adult and
adolescent preferences differ?

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Acknowledgements
• This presentation reports the methods and findings of a
study funded by the EuroQol Research Foundation
• The views expressed do not necessarily reflect the views
of the EuroQol Research Foundation
• The study is a collaboration with:
• Oliver Rivero-Arias (University of Oxford; co-PI)
• Nancy Devlin (Office of Health Economics; co-PI)
• David Mott (Office of Health Economics)
• Juan Manuel Ramos-Goñi (EuroQol Office)

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EQ-5D-Y: state of play
• EQ-5D-Y – ‘youth’ version of the EQ-5D
• Use is modest but growing
• No values sets available to support its use in economic
evaluation (cost-utility analysis)
• Recent research has indicated that regular EQ-5D-3L
value sets cannot be used for children and adolescents

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EQ-5D-Y instrument

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Whose preferences?
• Normative issue: whose preferences should we elicit?
• Position adopted by decision makers in the UK, US,
Netherlands (amongst others): relevant preferences are
those of the general public
• The UK is not prescriptive about who constitutes a
member of the public, but there seems to be an implicit
consensus:
• Those who bear the cost of providing health care
• Those eligible to vote
• These criteria exclude children and adolescents

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Alternative view
• Preferences of children and adolescents are relevant
because they are potential patients / users of the health
care being evaluated
• These preferences may also be relevant in other (non-
HTA) uses of the instrument
• Alternatives to conventional techniques now available
that may be suitable for eliciting the preferences of
younger people

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• Internet survey
• 15 DCE (paired comparison) tasks per respondent
• Blocked Bayesian efficient design (150 pairs in total)
• Plus one fixed pair (dominance test in which one health
state logically dominated the other)
• Each task asks respondents to choose which of two EQ-
5D-Y health states they prefer
• Discrete choice data analysed by estimating mixed logit
models with correlated parameters
Latent scale DCE study

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Adult vs. adolescent comparison
n=1,000
18+ years
Child health perspective:
respondents asked to
consider the health of a
10 year old child
Adult survey Adolescent survey
n=1,005
11-17 years
Own health perspective:
respondents asked to
consider their own health

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DCE task screenshot (adult)

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DCE task screenshot (adolescent)

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% choosing A/B - adults

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% choosing A/B - adolescents
Dominance test Adolescents Adults
Proportion selecting
dominant alternative
88.5% 89.5%

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Relative importance of dimensions

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Debriefing questions (freq, %)
Adolescents Adults
Found the tasks difficult:
Strongly disagree 208 (20.7%) 217 (21.7%)
Disagree 307 (30.6%) 290 (29.0%)
Neither agree nor disagree 224 (22.3%) 226 (22.6%)
Agree 226 (22.5%) 224 (22.4%)
Strongly agree 40 (4.0%) 43 (4.3%)
Found difficult to imagine the
health problems described:
Strongly disagree 105 (10.5%) 185 (18.5%)
Disagree 248 (24.7%) 329 (32.9%)
Neither agree nor disagree 213 (21.2%) 209 (20.9%)
Agree 369 (36.7%) 206 (20.6%)
Strongly agree 70 (7.0%) 71 (7.1%)

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Discussion
• Study demonstrates high level of completeness and
understanding by adolescents
• Some differences evident when comparing adult and
adolescent preferences
• Strong case for incorporating the views of adolescents as
part of ‘public preferences’ (perhaps alongside the views
of adults)
• Results can be considered alongside those of other
studies examining issues related to perspective, framing
and methodology in valuing the health of children

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To enquire about additional information and analyses, please contact
Koonal Shah at kshah@ohe.org
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