PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1375-1376 (doi:10.1542/peds.2004-1630)
Comments on the Prosser et al Approach to Value Disease Reduction in Children: In Reply
Lisa A. Prosser, PhDTracy A. Lieu, MD, MPH
Center for Child Health Care Studies
Department of Ambulatory Care and Prevention
Harvard Medical School and Harvard Pilgrim Health Care
Boston, MA 02215
Dr Beutels and Ms Viney suggest in their letter that we have departed from accepted methods for temporary health states in children. Valuing temporary health states has not received much attention in the health-state valuation literature and, contrary to their assertion, there are no widely accepted standards for valuing temporary health states. Several approaches have been suggested but not widely used.1–4 Our approach draws on one suggested method in which the temporary state is converted into a short-term chronic state to calculate the utility (or disutility) associated with a particular health state.5 The number of days traded off is divided by the length of the health state. This utility weight is then included in the cost-effectiveness analysis by prorating by the fraction of a year spent in the temporary health state. This method was modified for application to children's health by using the parent as the respondent (for more details, see ref 6).
An alternative approach is that described by Beutels and Viney in which the utility is calculated by dividing the number of days traded off by the respondent's remaining lifetime. This would be appropriate if the respondent had been asked to value the health state described as, for example, "7 days of otitis media followed by a lifetime of perfect health." In that case, it would be appropriate to scale the response as suggested, but it is not appropriate given our study design.
Valuing the health of very young children introduces additional challenges to the valuation task, including whose perspective should be used.7 Family spill-over effects (ie, the effect of a family member's illness on other family members) on health-related quality of life and the potential importance of including these effects in economic analyses can be quite significant for the very young and the very old.8,9 Our approach of valuing changes in health-related quality of life for both parent and child is consistent with the inclusion of family spill-over effects in the economic evaluation.
Valuing temporary health states will have increasing relevance as more preventive interventions that primarily reduce morbidity are introduced. We offer a new approach for providing health preferences for very young children for whom no standardized scores exist. To our knowledge, this study is the first to address both of these methodological challenges simultaneously. Certainly more research should be done to reach consensus in the field regarding optimal methods for valuing temporary health states in children.
REFERENCES
- Swan JS, Fryback DG, Lawrence WF, Sainfort F, Hagenauer ME, Heisey DM.. A time-tradeoff method for cost-effectiveness models applied to radiology.
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[Abstract/Free Full Text] - Swan JS, Sainfort F, Lawrence WF, Kuruchittham V, Kongnakorn T, Heisey DM. Process utility for imaging in cerebrovascular disease. Acad Radiol. 2003;10 :266 –274[CrossRef][Web of Science][Medline]
- 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 –1703[CrossRef][Web of Science][Medline]
- Johnston K, Brown J, Gerard K, O'Hanlon M, Morton A. Valuing temporary and chronic health states associated with breast screening. Soc Sci Med. 1998;47 :213 –222
- Bennett J, Torrance GW. Measuring health state preferences and utilities: rating scale, time trade-off, and standard gamble techniques. In: Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd ed. Philadelphia, PA: Lippincott-Raven Publishers; 1996
- Prosser LA, Lieu TA.Response to Beutels & Viney. Available at: www.pediatrics.org/cgi/eletters/113/2/283
- Petrou P. Methodological issues raised by preference-based approaches to measuring the health status of children. Health Econ. 2002;12 :697 –702
- Basu A, Meltzer D. Spillover effects of patient's health on family members and its implications to cost-effectiveness analysis [abstract]. Med Decis Making. 2003;23 :564
- Langa KM. An illness in the family: accounting for the complex effects of illness on other family members. Am J Manag Care. 2004;10 :305 –306[Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
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Related articles in Pediatrics:
- Comments on the Prosser et al Approach to Value Disease Reduction in Children
- Philippe Beutels and Rosalie C. Viney
Pediatrics 2004 114: 1375.[Extract] [Full Text]
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