Paediatric Quality of Life
The development of a paediatric health related quality of life measure for use in economic evaluation: The Child Health Utility 9D (CHU 9D)
Use of economic evaluation to aid NHS decision making is widespread. Cost utility analysis allows comparison of interventions both within and between disease areas by using outcome measures that combine length of life and quality of life into a single summary measure, conventionally the quality adjusted life year (QALY). Generic preference based health related quality of life measures have been developed for adults for this purpose. Research in this area for paediatric populations is more limited.
In 2005 Katherine Stevens was awarded an MRC Special Training Fellowship to develop a paediatric health related quality of life measure for use in economic evaluation, the Child Health Utility 9D (CHU9D). In 2009 she was awarded an ESRC/MRC/NIHR Early Career Post Doctoral Fellowship in the Economics of Health to further develop and apply this new measure.
Development of the CHU9D
The first stage of the research developed the descriptive system. Interviews were carried out with over 70 children during 2006, from two schools in Sheffield, in order to determine what dimensions of health related quality of life were included. These dimensions were then used as the basis for developing the descriptive system.
This descriptive system was then piloted with 150 children in schools.
Schools involved in the research:
Further testing of the draft descriptive system was carried out on a clinical population at the Sheffield Children's Hospital, in collaboration with the newly established Clinical Reseach Facility. This work tested the psychometric performance of the instrument on 95 children, including children from the medical and surgical wards as well as day care patients. The results of this work and the piloting in schools was used to refine the descriptive system.
The final stage of the work was to obtain values for the health states described by the descriptive system from a sample of the UK general population using the standard gamble method.
There are currently a number of studies underway involving the CHU9D. There are over 35 research studies applying the CHU9D, including clinical trials, observational studies, cohort studies and others. These studies are taking place in the UK, US, Canada, Australia and New Zealand.
Collaborative work with Professor Julie Ratcliffe at Flinders University, Australia has led to pilot adolescent preference weights for the CHU9D being generated. Details can be found on the publications page. Dr Katherine Stevens and Professor John Brazier are also working with Professor Ratcliffe on an NHMRC grant she is leading "Adolescent population health: application of Best-Worst Scaling Discrete Choice Experiments to value health states for use in economic evaluation" which will generate the definitive adolescent values. This is due for completion at the end of 2013.
More information on this research will appear here as the work progresses; however, if you would like further information, please contact Katherine Stevens.