Psychometric Performance of Preference-Weighted Instruments in Older Adults: A Systematic Review

Population aging is a major public health concern. Preference-weighted instruments are widely used to assess health-related quality of life and inform cost-effectiveness analyses. Given the range of available measures, it is important to identify those most suitable for older adults. This study systematically reviewed evidence on the psychometric properties of preference-weighted measures in older adults.

Four databases (Medline, Embase, PsycINFO, and CINAHL) were searched, supplemented by citation tracking. Peer-reviewed studies assessing the psychometric properties of preference-weighted measures in adults aged ≥60 were included. Two reviewers independently screened and extracted data. Methodological quality was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instrument risk of bias checklist, and evidence was graded using a modified GRADE approach.

A total of 106 studies were included, covering EQ-5D-3L (4), EQ-5D-5L (34), ICECAP-O (29), ASCOT (15), QOL-ACC (9), HUI3 (8), HUI2 (7), QWB (5), EQ-HWB-9 (5), WOOP (3), SF-6D (3), AQoL-8D (2), AQoL-4D (1), and 15D (1). EQ-5D versions showed acceptable performance on some criteria, although ceiling effects, limited interrater reliability, and inconsistent responsiveness were reported. ICECAP-O and ASCOT showed more consistent evidence, but both need further testing on responsiveness. Limited and mixed findings were available for other measures. Early evidence for QOL-ACC and WOOP was promising but incomplete. Although interrater reliability and responsiveness evidence remained limited across all measures, specific measures performed generally better than generic measures but had fewer studies.

Preference-weighted measures are widely used with older adults, but psychometric evidence remains incomplete because of limited assessment of responsiveness, few head-to-head comparisons, and lack of age-group-specific analyses.