Dutch policymakers' views on what justifies involving children in health state valuation: A Q-methodology study

Economic evaluations of interventions aimed at younger populations often use health state values based on preferences of adults regarding children's health states. Although it has been argued that children should be involved in the process of valuing health states, it remains unclear which arguments are relevant to policymakers to justify such involvement. The aim of this Q-methodology study was to identify and examine viewpoints of Dutch policymakers regarding which arguments justify involving children in the health state valuation (HSV) process. Policymakers (n = 18) ranked 29 statements, based on two recent reviews, describing arguments potentially justifying the involvement of children in the HSV process, and explained their ranking. Interviews took place from February to April 2025. Four viewpoints were identified. Participants with viewpoint 1 maintain a contributory perspective and consider children's contributions a way to improve the accuracy of values. Those with viewpoint 2 hold a societal perspective, highlighting the inherent social value of children's involvement in the HSV process. Viewpoint 3 describes children's involvement from a moral perspective, with justifications based on moral arguments. Those with viewpoint 4 maintain an instrumental perspective in which involving children increases the legitimacy of decisions. Most policymakers supported involving children in the HSV process. Common methodological and ethical concerns about involving children in this process had limited support. The four viewpoints suggest that the support for involvement of children in the HSV process rests on different underlying rationales. Future research could investigate how to involve children in the HSV process, and how such involvement relates to the viewpoints identified in our paper.