Skip to main content
SpringerLink
Log in

Measuring Health Preferences for Use in Cost-Utility and Cost-Benefit Analyses of Interventions in Children

Theoretical and Methodological Considerations

  • Leading Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Valuing the health of children for cost-utility or cost-benefit analysis poses a number of additional challenges when compared with valuing adult health. Some of these challenges relate to the inability of young children to value changes in health directly and the potential biases associated with using proxy respondents. Other challenges arise from children not being able to perform as independent economic actors, but dependent on others for care and decision making. In addition, illness in children may affect parent/caregiver quality of life, further complicating the measurement of value associated with a change in a child’s health status.

We review the most common approaches (QALYs and willingness-to-pay values) for valuing health in economic evaluations and consider the methodological and practical issues associated with measuring child health using each framework. Recommendations for advancing the field of valuing child health for economic evaluations will vary by age; a ‘one size fits all’ approach does not readily fit. Although limitations exist for all of the methods considered for valuing child health, the currently recommended approach for infants and preschoolers is direct valuation by a proxy respondent. For school-age children and adolescents, existing multi-attribute instruments can be applied in some situations but direct valuation may be required for others. Future research should focus on minimising bias from proxy respondents, consideration of a family- or household-based approach to valuing health effects, and development of generic instruments with domains that are appropriate to children and that vary with age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

References

  1. IOM Board on Health Care Services, Committee to Evaluate Measures of Health Benefits for Environmental Health and Safety Regulations. Miller W, Robinson LA, Lawrence RS, editors. Valuing health for regulatory cost-effectiveness analysis. Washington, DC: The National Academies Press, 2006: 1–380

  2. US Environmental Protection Agency, Office of Children’s Health Protection. Children’s health valuation handbook. Washington: EPA, 2003 [online]. Available from URL: http://yosemite.epa.gov/ee/epa/eed.nsf/pages/handbookchildren-shealthvaluation.html [Accessed 2007 Aug 23]

    Google Scholar 

  3. Organisation for Economic Cooperation and Development (OECD). Economic valuation of environmental health risks to children. Paris: OECD Publishing, 2006

    Google Scholar 

  4. Keren R, Pati S, Feudtner C. The generation gap: differences between children and adults pertinent to economic evaluations of health interventions. Pharmacoeconomics 2004; 22: 71–81

    Article  PubMed  Google Scholar 

  5. Griebsch I, Coast J, Brown J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatrics 2005; 115: e600–e6008

    Article  PubMed  Google Scholar 

  6. Matza LS, Swensen AR, Flood EM, et al. Assessment of health-related quality of life in children: a review of conceptual, methodological, and regulatory issues. Value Health 2004; 7: 79–92

    Article  PubMed  Google Scholar 

  7. Ungar WJ, Santos MT. Quality appraisal of pediatric health economic evaluations. Int J Technol Assess Health Care 2005; 21: 203–210

    PubMed  Google Scholar 

  8. Ladapo JA, Neumann PJ, Keren R, et al. Valuing children’s health: a comparison of cost-utility analyses for adult and pediatric health interventions. Pharmacoeconomics. In press

  9. Varni JW, Seid M, Rode CA. The PedsQL: measurements model for the pediatric quality of life inventory. Medical Care 1998; 37: 126–139

    Article  Google Scholar 

  10. Raat H, Bottweweck A, Landgraf JM, et al. Reliablity and validity of the short form of child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples. J Epidemiol Community Health 2005; 59 (1): 75–82

    Article  PubMed  Google Scholar 

  11. Robitail S, Simeoni MC, Erhart M, et al. Validation of the European proxy KIDSCREEN-52 pilot test health-related quality of life questionnaire: first results. J Adolesc Health 2006; 39: el–e10

    Article  Google Scholar 

  12. Vogels T, Verrips GH, Verloove-Vanhorick SP, et al. Measuring health-related quality of life in children: the development of the TACQOL parent form. Qual Life Res 1998; 7: 457–465

    Article  PubMed  CAS  Google Scholar 

  13. Bennett KJ, Torrance GW. Measuring health state preferences and utilities: rating scale, time trade-off, and standard gamble techniques. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia (PA): Lippincott-Raven, 1996: 253–265

    Google Scholar 

  14. Russell LB, Gold MR, Siegel JE, et al. The role of cost-effectiveness analysis in health and medicine. JAMA 1996; 276: 1172–1177

    Article  PubMed  CAS  Google Scholar 

  15. Neumann PJ, Goldie S J, Weinstein MC. Preference-based measures in economic evaluation in health care. Annu Rev Pub Health 2000: 21: 1–25

    Article  Google Scholar 

  16. Gold MR, Siegel JE, Russell LB, et al, editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996

    Google Scholar 

  17. Eiser C, Morse R. Quality-of-life measures in chronic diseases of childhood. Health Technol Assess 2001; 5: 1–156

    PubMed  CAS  Google Scholar 

  18. Harbaugh WT. Valuing children’s health and life: what does economic theory say about including parental and societal willingness to pay? [working paper]. Eugene (OR): University of Oregon Economics Department, 2001: 19

    Google Scholar 

  19. Bergstrom T. Valuing environmental health risk reductions to children: proceedings of session II. Household decision making. A workshop sponsored by the US Environmental Protection Agency’s NCEE, NCER, and Office of Children’s Health Protection; and the University of Central Florida; Washington, DC; 2003 Oct 20–21 [online]. Available from URL: http://es.epa.gov/ncer/publications/workshop/pdf/EE-0475-03.pdf [Accessed 2007 Jul 27]

    Google Scholar 

  20. Cockerill CA, Chilton SM, Hutchinson WG. How does the choice of household decision making model affect the value of child safety? Paper presented at the Third World Congress of Environmental and Resource Economists; 2006 Jul 3–7; Kyoto

    Google Scholar 

  21. Petrou S. Methodological issues raised by preference-based approaches to measuring the health status of children. Health Econ 2003; 12: 697–702

    Article  PubMed  Google Scholar 

  22. Rosenbaum PL, Saigal S. Measuring health-related quality of life in pediatric populations: conceptual issues. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia (PA): Lippincott-Raven Publishers, 1996: 785–791

    Google Scholar 

  23. De Civita M, Regier D, Alamgir AH, et al. Evaluating health-related quality-of-life studies in paediatric populations: some conceptual, methodological and developmental considerations and recent applications. Pharmacoeconomics 2005; 23: 659–685

    Article  PubMed  Google Scholar 

  24. Pliskin JS, Shepard DS, Weinstein MC. Utility functions for life years and health status. Oper Res 1980; 28: 206–224

    Article  Google Scholar 

  25. Bleichrodt H, Wakker P, Johannesson M. Characterizing QALYs by risk neutrality. J Risk Uncertain 1997; 15: 107–114

    Article  Google Scholar 

  26. Johannesson M, Pliskin JS, Weinstein M. A note on QALYs, time tradeoff, and discounting. Med Dec Making 1994; 14: 188–193

    Article  CAS  Google Scholar 

  27. Wakker P, Stiggelbout A. Explaining distortions in utility elicitation through the rank-dependent model for risky choices. Med Dec Making 1995; 15: 180–186

    Article  CAS  Google Scholar 

  28. Bleichrodt H, Diecidue E, Quiggin J. Equity weights in the allocation of health care: the rank-dependent QALY model. J Health Econ 2004; 23: 157–171

    Article  PubMed  Google Scholar 

  29. Mehrez A, Gafni A. The healthy-years equivalents. Med Decis Making 1991; 11: 140–146

    Article  PubMed  CAS  Google Scholar 

  30. Lieu TA, McGuire TG, Hinman AR. Overcoming economic barriers to the optimal use of vaccines. Health Aff 2005; 24: 666–679

    Article  Google Scholar 

  31. Lee GM, Salomon JA, LeBaron C, et al. Health-state valuations for pertussis: methods for valuing short-term health states. Health Qual Life Outcomes 2005; 3: 17–31

    Article  PubMed  Google Scholar 

  32. Bala MV, Wood LL, Zarkin GA, et al. Are health states “timeless”? The case of the standard gamble method. J Clin Epidemiol 1999; 52: 1047–1053

    Article  PubMed  CAS  Google Scholar 

  33. Binkin NJ, Koplan JP. The high cost and low efficacy of weekly viral cultures for pregnant women with recurrent genital herpes: a reappraisal. Med Decis Making 1989; 9: 225–230

    Article  PubMed  CAS  Google Scholar 

  34. Rowley PT, Loader S, Kaplan RM. Prenatal screening for cystic fibrosis carriers: an economic evaluation. Am J Hum Genet 1998; 63: 1160–1174

    Article  PubMed  CAS  Google Scholar 

  35. Prosser LA, Ray GT, O’Brien M, et al. Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine. Pediatrics 2004; 113: 283–290

    Article  PubMed  Google Scholar 

  36. Basu A, Meltzer D. Implications of spillover effects within the family for medical cost-effectiveness analysis. J Health Econ 2005; 24: 751–773

    Article  PubMed  Google Scholar 

  37. Hammitt IK. Willingness to pay and quality adjusted life years. In: Scapecchi P, editor. Economic valuation of environmental health risks to children. Paris: OECD Publishing, 2006: 239–272

    Google Scholar 

  38. Drummond MF, Sculpher MI, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press, 2005

    Google Scholar 

  39. Liu I, Hammitt IK, Wang I, et al. Mother’s willingness to pay for her own and her child’s health: a contingent valuation study in Taiwan. Health Econ 2000; 9: 319–326

    Article  PubMed  CAS  Google Scholar 

  40. Dickie M, Messman VL. Parental alturism and the value of avoiding acute illness: are kids worth more than parents? J Environ Econ Mgmt 2004; 48: 1146–1174

    Article  Google Scholar 

  41. Prosser LA, Bridges CB, Uyeki TM, et al. Values for preventing influenza-related morbidity and vaccine adverse events in children. Health Qual Life Outcomes 2005; 3: 1–16

    Article  Google Scholar 

  42. Juniper EF, Guyatt GH, Feeny DH, et al. Minimum skills required by children to complete health-related quality of life instruments for asthma: comparison of measurement properties. Eur Respir 11997; 10: 2285–2294

    Article  Google Scholar 

  43. Saigal S, Stoskopf BL, Feeny D, et al. Differences in preferences for neonatal outcomes among health care professionals, parents, and adolescents. IAMA 1999; 281: 1991–1997

    Article  CAS  Google Scholar 

  44. Saigal S, Rosenbaum PL, Feeny D, et al. Parental perspectives of the health status and health-related quality of life of teen-aged children who were extremely low birth weight and term controls. Pediatrics 2000; 105: 569–574

    Article  PubMed  CAS  Google Scholar 

  45. Saigal S, Rosenbaum PL, Hoult L, et al. Conceptual and methodological issues in assessing health-related quality of life in children and adolescents: illustration from studies of extremely low birthweight survivors. In: Drotar D, editor. Measuring health-related quality of life in children and adolescents: implications for research and practice. Mawah (NI): Lawrence Erlbaum Associates, 2006: 151–169

    Google Scholar 

  46. Nightingale EO, Fischhoff B. Adolescent risk and vulnerability: overview. J Adolescent Health 2002; 315: 3–9

    Article  Google Scholar 

  47. Millstein SG, Halpern-Felsher BL. Perceptions of risk and vulnerability. J Adolescent Health 2002; 31S: 10–27

    Article  Google Scholar 

  48. Woloshin S, Schwartz LM, Moncur M, et al. Assessing values for health: numeracy matters. Med Dec is Making 2001; 21: 382–390

    Article  CAS  Google Scholar 

  49. Nord E. Cost-value analysis in health care: making sense out of QALYs. New York: Cambridge University Press, 1999

    Google Scholar 

  50. Ravens-Sieberer U, Erhart M, Wille N, et al. Generic health-related quality-of-life assessment in children and adolescents: methodological considerations. Pharmacoeconomics 2006; 24: 1199–1220

    Article  PubMed  Google Scholar 

  51. Brock DW. Ethical issues in the use of cost effectiveness analysis for the prioritization of health care resources. In: Anand S, Peter F, Sen A, editors. Public health, ethics, and equity. New York: Oxford University Press, 2004: 201–224

    Google Scholar 

  52. Neumann PI, Kuntz KM, Leon I, et al. Health utilities in Alzheimer’s disease: a cross-sectional study of patients and caregivers. Med Care 1999; 37: 27–32

    Article  PubMed  CAS  Google Scholar 

  53. Ryan M, Scott DA, Donaldson C. Valuing health care using willingness to pay: a comparison of the payment card and diehotomous choice methods. J Health Econ 2004; 23: 237–258

    Article  PubMed  Google Scholar 

  54. Shaw IW, Johnson IA, Coons SI. US valuation of the EQ-5D health states: development and testing of the Dl valuation model. Med Care 2005; 43: 203–220

    Article  PubMed  Google Scholar 

  55. Feeny D, Furlong W, Boyle M, et al. Multi-attribute health status classification systems: Health Utilities Index. Pharmacoeconomics 1995; 7: 490–502

    Article  PubMed  CAS  Google Scholar 

  56. Sieber WI, Groessl EI, David KM, et al. Quality of well-being scale self-administered (QWB-SA) scale. San Diego (CA): Health Outcomes Assessment Program, 2004: 1–38

    Google Scholar 

  57. Hennessy S, Kind P. Measuring health status in children: developing and testing a child-friendly version of EQ-5D. 19th Plenary Meeting of the EuroQol Group; 2002 Sep 13–14; York: 219–310

    Google Scholar 

  58. Torrance GW, Feeny D, Furlong WI, et al. Multiattribute utility function for a comprehensive health status classification system: Health Utilities Index Mark 2. Med Care 1996; 34 (7): 702–722

    Article  PubMed  CAS  Google Scholar 

  59. Feeny D, Furlong W, Torrance GW, et al. Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Med Care 2002; 40 (2): 113–128

    Article  PubMed  Google Scholar 

  60. Brazier I, Roberts I, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002; 21: 271–292

    Article  PubMed  Google Scholar 

  61. Bryan S, Parkin D, Donaldson C. Chiropody and the QALY: a case study in assigning categories of disability and distress to patients. Health Policy 1991; 18: 169–185

    Article  PubMed  CAS  Google Scholar 

  62. Erickson P. Modeling health-related quality of life: the bridge between psychometric and utility based measures. J Natl Cancer Inst Monogr 1996; 20: 17–22

    PubMed  Google Scholar 

  63. Kelly AE Haddix AC, Scanlon KS, et al. Cost-effectiveness of strategies to prevent neural tube defects. In: Gold MR, Russell LB, Siegel IE, et al., editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996: 313–348

    Google Scholar 

  64. Dolan P. Output measures and valuation in health. In: Dummond M, McGuire A, editors. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001: 46–67

    Google Scholar 

  65. Stalmeier PFM, Goldstein MK, Holmes AM, et al. What should be reported in a methods section on utility assessment? Med Dec Making 2001; 21: 200–207

    CAS  Google Scholar 

  66. Boyle MH, Offord DR, Hofmann HG, et al. Ontario child health study: 1. Methodology. Arch Gen Psychiatry 1987; 44: 826–831

    Article  PubMed  CAS  Google Scholar 

  67. Raat H, Landgraf JM, Oostenbrink R, et al. Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample. Qual Life Res 2007; 16: 445–460

    Article  PubMed  Google Scholar 

  68. Eisen M, Ware IE, Donald C, et al. Measuring components of children’s health status. Med Care 1979; 17: 902–921

    Article  PubMed  CAS  Google Scholar 

  69. Landgraf JM, Abetz LN. Measuring health outcomes in pediatric populations: issues in psycho metrics. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia (PA): Lippincott-Raven Publishers, 1996: 793–802

    Google Scholar 

  70. Swan JS, Fryback DG, Lawrence WF, et al. A time-tradeoff method for cost-effectiveness models applied to radiology. Med Decis Making 2000; 20: 79–88

    Article  PubMed  CAS  Google Scholar 

  71. Phillips KA, Maddala T, Johnson FR. Measuring preferences for health care interventions using conjoint analysis: an application to HIV testing. Health Serv Res 2002; 37: 1681–1705

    Article  PubMed  Google Scholar 

  72. Johnston K, Brown J, Gerard K, et al. Valuing temporary and chronic health states associated with breast screening. Soc Sci Med 1998; 47: 213–222

    Article  PubMed  CAS  Google Scholar 

  73. Swan JS, Sainfort F, Lawrence WF, et al. Process utility for imaging in cerebrovascular disease. Acad Rad 2003; 10: 266–274

    Article  Google Scholar 

  74. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002; 21 (2): 271–292

    Article  PubMed  Google Scholar 

  75. Dolan P, Kind P. Inconsistency and health state valuations. Soc Sci Med 1996; 42: 609–615

    Article  PubMed  CAS  Google Scholar 

  76. Dolan P. The measurement of health-related quality of life for use in resource allocation decisions in health care. In: Culyer A J, Newhouse JP, editors. Handbook of health economics. Boston (MA): Elsevier Inc., 2000: 1723–1760

    Google Scholar 

  77. Ryan M, Farrar S. Using conjoint analysis to elicit preferences for health care. BMJ 2000; 320: 1530–1533

    Article  PubMed  CAS  Google Scholar 

  78. Hauber AB, Johnson FR, Sauriol L, et al. Risking health to avoid injections: preferences of Canadians with type 2 diabetes. Diabetes Care 2005; 28: 2243–2245

    Article  PubMed  Google Scholar 

  79. Osoba D, Hsu M, Copley-Merriman C, et al. Stated preferences of patients with cancer for health-related quality-of-life (HRQOL) domains during treatment. Qual Life Res 2006; 15: 273–283

    Article  PubMed  Google Scholar 

  80. Salomon JA. Reconsidering the use of rankings in the valuation of health states: a model for estimating cardinal values from ordinal data. Popul Health Metr 2003; 1: 12

    Article  PubMed  Google Scholar 

  81. Bryan S, Dolan P. Discrete choice experiments in health economics: for better or worse? Eur J Health Econ 2004; 5: 202

    Article  Google Scholar 

Download references

Acknowledgements

Dr Keren was supported by grant D23 HD043179 from the National Institute of Child Health and Human Development, NIH. The authors have no conflicts of interest that are directly relevant to the contents of this review.

The authors greatly appreciate helpful comments from Milt Weinstein, Tracy Lieu and attendees of the Center for Child Health Care Studies Work in Progress Seminar regarding earlier versions of this manuscript.

Author information

Authors and Affiliations

  1. Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, Massachusetts, 02215, USA

    Lisa A. Prosser

  2. Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts, USA

    James K. Hammitt

  3. Division of General Pediatrics, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    Ron Keren

Authors
  1. Lisa A. Prosser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James K. Hammitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ron Keren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa A. Prosser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Prosser, L.A., Hammitt, J.K. & Keren, R. Measuring Health Preferences for Use in Cost-Utility and Cost-Benefit Analyses of Interventions in Children. Pharmacoeconomics 25, 713–726 (2007). https://doi.org/10.2165/00019053-200725090-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200725090-00001

Keywords

Search

Navigation