Revisiting the Valuation of Child Health-Related Quality of Life: Replacing Paired Comparisons With Kaizen Tasks and QALY Scaling With Experience Scaling.

Abstract

Objectives: In 2013, the EQ-5D-Y-3L valuation study conducted by Craig and colleagues (ie, the original study) of child health-related quality of life (HRQoL) revealed that U.S. respondents often found it burdensome and guilt-inducing to choose between hypothetical health problems of children. This study introduces an alternative approach where respondents sequentially relieve the health problems of a 10-year-old child for 1 week.

Methods: We conducted a discrete choice experiment (DCE) survey (N=631) with paired comparisons and kaizen tasks. Each kaizen task displayed a single profile of a child's HRQoL using the EQ-5D-Y-3L descriptive system and asked respondents to select first, second, and third improvements for the child's problems. Combining the preference evidence, a conditional logit model was estimated to produce EQ-5D-Y-3L values on an "experience" scale, where positive values signify experiences better than "being in a coma" and negative values worse.

Results: All 10 main effects were statistically significant ( P <0.01), with the highest value placed on alleviating pain and discomfort. The worst-case scenario (33333) had a value of -0.337 on the experience scale, indicating it is worse than a coma. These new estimates highly correlate with the original U.S. EQ-5D-Y-3L values (Pearson correlation=0.726; Spearman correlation=0.794).

Conclusion: This innovative approach to child health valuation replaces paired comparisons with Kaizen tasks, reducing respondent burden and study costs. Its use of experience scaling, instead of QALYs, aligns with U.S. guidelines (eg, the Inflation Reduction Act of 2022) and summarizes child HRQoL gains for health technology assessment.