Can adult weights be used to value child health states? Testing the influence of perspective in valuing EQ-5D-Y

Purpose To test whether or not adults assign the same values to hypothetical health states that describe health in adults as when those same descriptions refer to the health of a child. Methods A two-part self-completion questionnaire was designed in which respondents were asked firstly to rate a fixed set of EQ-5D-Y health states on a 0–100 visual analogue scale as if they themselves were in these states. Two versions of the questionnaire were produced each with a different second part. One version instructed respondents to value the same states but to imagine them describing another adult. The second version required respondents to value these states as if they applied to a 10-year-old child. Questionnaires were distributed to adults recruited in three countries (Germany, Spain and England) using convenience sampling methods. Results A total of 1085 questionnaires were completed. Despite some significant differences in the characteristics of the achieved samples in the three countries involved, the rank order of health states was largely consistent across each adult/child reference perspective. In all countries, the mean values were lower when health states described children rather than adults. Significant differences were found for 16/24 states when values for those states applied to adult respondent themselves were compared with the values for those states applied to a 10-year-old child. A near-uniform pattern was found across all three countries in which health state values for children were found to be lower than for adults. Conclusions Values for health states when ascribed to adults are higher than when those same states are associated with children. Were EQ-5D-3L values for adults applied to EQ-5D-Y health states, then this would effectively lead to an misrepresentation of the value assigned to a health status in children