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Generic Health-Related Quality of Life Utility Measure for Preschool Children (Health Utilities Preschool): Design,
William Furlong1, Charlene Rae2, David Feeny1
1Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
Insights
The Health Utilities Preschool (HuPS) is a new, reliable, and valid generic preference-based measure for assessing preschooler health. It extends the Health Utilities Index 3 (HUI3) to younger children, aiding health policy decisions.
Area of Science:
- Health Economics
- Pediatric Health Outcomes
- Psychometrics
Background:
- Generic preference-based measures (GPMs) are crucial for health policy decisions, particularly for summarizing health outcomes like quality-adjusted life-years.
- Existing GPMs often lack applicability in early childhood, creating a need for measures suitable for preschool-aged children.
Purpose of the Study:
- To develop and evaluate the Health Utilities Preschool (HuPS), a GPM designed for children aged 2 years and older.
- To ensure HuPS is acceptable, reliable, valid, and continuous with existing measures like the Health Utilities Index 3 (HUI3).
Main Methods:
- HuPS development followed established standards, incorporating components from the Health Status Classification System for Preschool Children and HUI3.
- Four measurement surveys (definitional, adaptational, quantificational, evaluational) were conducted to develop and refine HuPS.
- Reliability, validity, interpretability, and acceptability of HuPS were rigorously evaluated.
Main Results:
- HuPS identified 8 common health attributes with HUI3, enabling commensurate scoring.
- Adaptational measurements defined 35 attribute-level descriptions.
- Excellent inter-rater reliability (ICC=0.79) and reliable/valid continuity with HUI3 (ICC=0.80, MAD=0.016) were achieved.
Conclusions:
- HuPS is an acceptable, reliable, and valid GPM for preschool-aged children.
- The continuity of HuPS with HUI3 extends the applicability of HUI3 scoring to children as young as 2 years.
- Widespread use of HuPS can inform health policy and management decisions for young populations, similar to HUI3 for older individuals.
Objectives:
Health Utilities Preschool (HuPS) was developed to fill the need for a generic preference-based measure (GPM) applicable in early childhood. A GPM has all the properties for higher-order summary measures, such as quality-adjusted life-years, required to inform important policy decisions regarding health and healthcare services.
Methods:
Development was in accordance with published standards for a GPM, statistical procedures, and modeling. HuPS incorporates key components of 2 existing measurement systems: Health Status Classification System for Preschool Children and Health Utilities Index Mark 3 (HUI3). The study included a series of 4 measurement surveys: definitional, adaptational, quantificational, and evaluational health-related quality of life (HRQL). HuPS measurements were evaluated for reliability, validity, interpretability, and acceptability.
Results:
Definitional measurements identified 8 Health Status Classification System for Preschool Children attributes in common with HUI3 (vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain and discomfort), making the HUI3 scoring equation commensurate with HuPS health states. Adaptational measurements informed the content of attribute-level descriptions (n = 35). Quantificational measurements determined level scoring coefficients. HRQL scoring inter-rater reliability (intraclass correlation coefficient = 0.79) was excellent. Continuity of HRQL scoring with HUI3 was reliable (intraclass correlation coefficient = 0.80, P < .001) and valid (mean absolute difference = 0.016, P = .396).
Conclusions:
HuPS is an acceptable, reliable, and valid GPM. HRQL scoring is continuous with HUI3. Continuity expands the applicability of GPM (HUI3) scoring to include subjects as young as 2 years of age. Widespread applications of HuPS would inform important health policy and management decisions as HUI3 does for older subjects.
