Comparison Of EQ-5D-Y Health Utility Value Sets In Five Countries

BackgroundAccurate and effective measurement of health utility value is the basis of pharmacoeconomic evaluation and will directly affect its application in health decision-making.The EuroQoL Five Dimensions Questionnaire(EQ-5D)is one of the most widely used Global Health Utility Scale.,and the utility value set is the basis of health utility scale measurement.The utility value set is culturally dependent.Many studies compare the utility value sets of adult version of EQ-5D(EQ-5D-3L and EQ-5D-5L)based on the preferences of the local population,and the research results show that the utility value sets of different countries are not interchangeable.The selection of utility value set in different countries will affect the result of cost-utility analysis.There are many challenges in the measurement of health utility of adolescents and adolescents.In 2009,EuroQol five Dimensional Questionnaire for Youth(EQ-5D-Y)was developed and published,but it was not until 2021 that Slovenia published the first EQ-5D-Y scale utility value set.At present,eight countries including China have established and published their own utility value sets based on the international evaluation scheme of EQ-5D-Y,but no comparative study has been carried out on the utility value sets of EQ-5D-Y scale.ObjectivesThis study aimed to use EQ-5D-Y to measure the health utility of primary school students(grades 3-6)in Shandong Province,compared the measuring performance of the utility value set of EQ-5D-Y scale in five countries(China,Japan,Slovenia,Spain,Germany),and comprehensively evaluated the utility value set of EQ-5D-Y.To provide basic data support and methodology reference for quality of life evaluation and health economics evaluation.MethodsThis study was a cross-sectional study design with multi-stage stratified sa mpling.An online questionnaire survey was conducted in Yantai,Jinan and He ze in Shandong Province in July 2021.The respondents were primary school s tudents from grade 3 to Grade 6.The questionnaire included information on so cio-demographic characteristics,the Child Health Utility 9D(CHU9D)and Euro Qol five Dimensional Questionnaire for Youth(EQ-5D-Y).The statistical metho d used mainly include descriptive analysis,non-parametric test,t test,Intraclass correlation coefficient(ICC),Bland-Altman plot,Spearman correlation,etc.ResultsA total of 41,917 primary school students were investigated,and 39,887 valid questionnaires were included in the final analysis,with the effective rate of 95.16%.The mean age of the sample population was 10.81±1.42.The ratio of male to female was balanced,with male students accounting for 51.92%.More than four fifths(85.88%)of the students were from public schools,and more than half(55.37%)of the students were from rural areas.The ceiling effect of EQ-5D-Y scale is 72.87%,and the distribution of health utility values under the five-country value set is not normal with the median of 1.The mean health utility values under the five-country value set from high to low are:Japan(0.964±0.080),China(0.962±0.091),Germany(0.943±0.136),Slovenia(0.930±0.168)and Spain(0.930±0.163)showed statistically significant differences in the mean health utility of the five countries.ICC between any two countries’ utility value sets is greater than 0.7,indicating that there is a high consistency among the five countries’ utility value sets of EQ-5D-Y scale.The ICC between Slovenia and Spain was the highest(0.997),followed by that between China and Japan(0.977).The limits of agreement of health utility between any two countries of the five-country value set in Bland-Altman plot is greater than the minimum significant difference of 0.03,and the difference has practical significance.In addition to 88.66%of the utility difference under the value set between China and Spain,more than 90%of the utility difference between the value set between the other five countries fell within the consistency limit,indicating a high level of consistency.The aggregate validity of EQ-5D-Y utility value set in five countries is moderately correlated with that of CHU9D scale in China.In terms of inter-group validity,the utility score system of the five countries can distinguish the inter-group differences of different grades and residence types.The sensitivity of utility value sets in the five countries is poor in the demographic characteristics of school type,residence,gender and grade,and the sensitivity of utility value sets in the five countries is similar on the whole.ConclusionsEQ-5D-Y can be used to measure the health utility of adolescents and children.Although there is a high consistency among the utility value sets of EQ-5D-Y five countries,hey cannot be substituted by each other.It is suggested that the comparison of utility value sets in different countries should be strengthened in the future,and its influence on the results of cost-utility analysis should be explored.