Paving the way for the use of the SDQ in economic evaluations of school-based population health interventions: an empirical analysis of the external validity of SDQ mapping algorithms to the CHU9D in an educational setting

Purpose

The Strengths and Difficulties Questionnaire (SDQ) is a behavioural screening tool for children. The SDQ is increasingly used as the primary outcome measure in population health interventions involving children, but it is not preference based; therefore, its role in allocative economic evaluation is limited. The Child Health Utility 9D (CHU9D) is a generic preference-based health-related quality of-life measure. This study investigates the applicability of the SDQ outcome measure for use in economic evaluations and examines its relationship with the CHU9D by testing previously published mapping algorithms. The aim of the paper is to explore the feasibility of using the SDQ within economic evaluations of school-based population health interventions.

Methods

Data were available from children participating in a cluster randomised controlled trial of the school-based roots of empathy programme in Northern Ireland. Utility was calculated using the original and alternative CHU9D tariffs along with two SDQ mapping algorithms. t tests were performed for pairwise differences in utility values from the preference-based tariffs and mapping algorithms.

Results

Mean (standard deviation) SDQ total difficulties and prosocial scores were 12 (3.2) and 8.3 (2.1). Utility values obtained from the original tariff, alternative tariff, and mapping algorithms using five and three SDQ subscales were 0.84 (0.11), 0.80 (0.13), 0.84 (0.05), and 0.83 (0.04), respectively. Each method for calculating utility produced statistically significantly different values except the original tariff and five SDQ subscale algorithm.

Conclusion

Initial evidence suggests the SDQ and CHU9D are related in some of their measurement properties. The mapping algorithm using five SDQ subscales was found to be optimal in predicting mean child health utility. Future research valuing changes in the SDQ scores would contribute to this research.

     

Mapping scores from the Strengths and Difficulties Questionnaire (SDQ) to preference-based utility values

Purpose

Quality of life mapping methods such as “Transfer to Utility” can be used to translate scores on disease-specific measures to utility values, when traditional utility measurement methods (e.g. standard gamble, time trade-off, preference-based multi-attribute instruments) have not been used. The aim of this study was to generate preliminary ordinary least squares (OLS) regression-based algorithms to transform scores from the Strengths and Difficulties Questionnaires (SDQ), a widely used measure of mental health in children and adolescents, to utility values obtained using the preference-based Child Health Utility (CHU9D) instrument.

Methods

Two hundred caregivers of children receiving community mental health services completed the SDQ and CHU9D during a telephone interview. Two OLS regressions were run with the CHU9D utility value as the dependent variable and SDQ subscales as predictors. Resulting algorithms were validated by comparing predicted and observed group mean utility values in randomly selected subsamples.

Results

Preliminary validation was obtained for two algorithms, utilising five and three subscales of the SDQ, respectively. Root mean square error values (.124) for both models suggested poor fit at an individual level, but both algorithms performed well in predicting mean group observed utility values.

Conclusion

This research generated algorithms for translating SDQ scores to utility values and providing researchers with an additional tool for conducting health economic evaluations with child and adolescent mental health data.     

A Review of the Psychometric Performance of Selected Child and Adolescent Preference-Based Measures Used to Produce Utilities for Child and Adolescent Health

ObjectiveThis review examined the psychometric performance of 4 generic child- and adolescent-specific preference-based measures that can be used to produce utilities for child and adolescent health.MethodsA systematic search was undertaken to identify studies reporting the psychometric performance of the Child Health Utility (CHU9D), EQ-5D-Y (3L or 5L), and Health Utilities Index Mark 2 (HUI2) or Mark 3 (HUI3) in children and/or adolescents. Data were extracted to assess known-group validity, convergent validity, responsiveness, reliability, acceptability, and feasibility. Data were extracted separately for the dimensions and utility index where this was reported.ResultsThe review included 76 studies (CHU9D n = 12, EQ-5D-Y-3L n = 20, HUI2 n = 26,HUI3 n = 43), which varied considerably across conditions and sample size. EQ-5D-Y-3L had the largest amount of evidence of good psychometric performance in proportion to the number of studies examining performance. The majority of the evidence related to EQ-5D-Y-3L was based on dimensions. CHU9D was assessed in fewer studies, but the majority of studies found evidence of good psychometric performance. Evidence for HUI2 and HUI3 was more mixed, but the studies were more limited in sample size and statistical power, which was likely to have affected performance.ConclusionsThe heterogeneity of published studies means that the evidence is based on studies across a range of countries, populations and conditions, using different study designs, different languages, different value sets and different statistical techniques. Evidence for CHU9D in particular is based on a limited number of studies. The findings raise concerns about the comparability of self-report and proxy-report responses to generate utility values for children and adolescents.     

Measuring and Valuing Health Benefits for Economic Evaluation in Adolescence: An Assessment of the Practicality and Validity of the Child Health Utility 9D in the Australian Adolescent Population

ObjectivesThe Child Health Utility 9D (CHU9D) is a new generic preference-based measure of health-related quality of life developed for children aged 7 to 11 years. There is increasing interest in its potential for application in adolescents, and previous research has demonstrated that it shows good construct validity here. This article further examines its practicality and validity in adolescents by comparing it with KIDSCREEN-10, a short generic measure for assessing children and adolescents’ health-related quality of life and well-being.MethodsA Web-based survey, including the CHU9D, a general health question, questions on the presence of long-standing illness, disability, or medical conditions, sociodemographic variables, and KIDSCREEN-10, was administered to 961 consenting adolescents. The practicality and face and construct validity of the CHU9D were examined, and the CHU9D and KIDSCREEN-10 were compared in terms of their coverage, correlations between dimensions, and overall scores.ResultsBoth measures demonstrated good practicality and validity. The strongest degree of correlation was found with the only dimension in common for the CHU9D and KIDSCREEN (sad). The lowest correlations were found between all the CHU9D dimensions and the “have you had enough time for yourself” dimension of KIDSCREEN-10.ConclusionsThe findings from this study provide further support for the practicality and validity of the application of the CHU9D in the economic evaluation of adolescent health care and public health programs. Further research to test the psychometric performance of the CHU9D in more diverse clinical samples of adolescents is desirable including tests of reliability.     

Assessing the Health-Related Quality of Life of Australian Adolescents: An Empirical Comparison of the Child Health Utility 9D and EQ-5D-Y Instruments

ObjectivesTo examine the performance of two recently developed preference-based instruments—the Child Health Utility 9D (CHU9D) and the EuroQol five-dimensional questionnaire Youth version (EQ-5D-Y)—in assessing the health-related quality of life (HRQOL) of Australian adolescents.MethodsAn online survey including the CHU9D and the EQ-5D-Y, self-reported health status, and a series of sociodemographic questions was developed for administration to a community-based sample of adolescents (aged 11–17 years). Individual responses to both instruments were translated into utilities using scoring algorithms derived from the Australian adult general population.ResultsA total of 2020 adolescents completed the online survey. The mean ± SD utilities of the CHU9D and the EQ-5D-Y were very similar (0.82 ± 0.13 and 0.83 ± 0.19, respectively), and the intraclass correlation coefficient (0.80) suggested good levels of agreement. Both instruments were able to discriminate according to varying levels of self-reported health status (P < 0.001). Although exhibiting good levels of agreement overall, some wide divergences were apparent at an individual level.ConclusionsThe study results are encouraging and illustrate the potential for both the CHU9D and the EQ-5D-Y to be more widely used for measuring and valuing the HRQOL of adolescent populations in Australia and internationally. Generating adolescent-specific scoring algorithms pertaining to each instrument and an empirical comparison of the resulting utilities is a natural next step. More evidence is required from the application of the CHU9D and the EQ-5D-Y in specific patient groups in adolescent health settings to inform the choice of instrument for measuring and valuing the HRQOL for the economic evaluation of adolescent health care treatments and services.     

Analysis of motivations for antiflu vaccination of the Clermont-Ferrand University Hospital staff

Objective

The vaccination of hospital staff decreases patient mortality and disorganization of services due to sick leave. The main aim of our study was to determine the Clermont-Ferrand University hospital (CHU) personnel’s motivations for or against antiflu vaccination to increase the effectiveness of prevention campaigns.

Design

An autoquestionnaire with multiple choices was given to the 7601 CHU staff in May 2005. It documented socioprofessional characteristics, vaccinal status, and reasons for vaccination, nonvaccination, or stopping antiflu vaccination.

Results

The answer rate was 26.5% (2011 autoquestionnaires returned) and representative of the CHU staff. The rate of vaccination in 2004 was 36.35% with a strong correlation between vaccination and former influenza infection (p < 0.001). Five of the six principal reasons for vaccination were altruistic including the first two: avoiding transmission to patients (61.8%) and his family (59.8%). The main reason for stopping was the lack of time. The reasons for nonvaccination were linked to a feeling of invulnerability: conviction of not being at risk, of being too young, or in good health.

Conclusions

The Haute Autorité de santé’s objective of vaccinal coverage against influenza for 75% of the health professionals requires their active compliance. The effectiveness of future campaigns could aim at improving knowledge by insisting particularly on the young age of the risk populations. The lack of time can be compensated by offering on-site vaccination, including at night and by proposing larger schedules for vaccination.     

Evidence of low vitamin D intakes in the Australian population points to a need for data-driven nutrition policy for improving population vitamin D status

Background

Nearly one in four Australian adults is vitamin D deficient (serum 25-hydroxyvitamin D concentrations [25(OH)D] < 50 nmol L^–1) and current vitamin D intakes in the Australian population are unknown. Internationally, vitamin D intakes are commonly below recommendations, although estimates generally rely on food composition data that do not include 25(OH)D. We aimed to estimate usual vitamin D intakes in the Australian population.

Methods

Nationally representative food consumption data were collected for Australians aged ≥ 2 years (n = 12,153) as part of the cross-sectional 2011–2013 Australian Health Survey (AHS). New analytical vitamin D food composition data for vitamin D₃, 25(OH)D₃, vitamin D₂ and 25(OH)D₂ were mapped to foods and beverages that were commonly consumed by AHS participants. Usual vitamin D intakes (µg day^–1) by sex and age group were estimated using the National Cancer Institute method.

Results

Assuming a 25(OH)D bioactivity factor of 1, mean daily intakes of vitamin D ranged between 1.84 and 3.25 µg day^–1. Compared to the estimated average requirement of 10 µg day^–1 recommended by the Institute of Medicine, more than 95% of people had inadequate vitamin D intakes. We estimated that no participant exceeded the Institute of Medicine's Upper Level of Intake (63–100 µg day^–1, depending on age group).

Conclusions

Usual vitamin D intakes in Australia are low. This evidence, paired with the high prevalence of vitamin D deficiency in Australia, suggests that data-driven nutrition policy is required to safely increase dietary intakes of vitamin D and improve vitamin D status at the population level.     

Association of serum 25-hydroxyvitamin D with the risk of death in a general older population in Finland

Purpose  

To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] concentration, a marker of vitamin D status, and risk of all-cause and cardiovascular mortality in a general older population with relatively low average serum 25(OH)D concentrations.     

Using the knee-specific Hughston Clinic Questionnaire, EQ-5D and SF-6D following arthroscopic partial meniscectomy surgery: a comparison of psychometric properties

Purpose  

To compare the psychometric properties of the Hughston Clinic Questionnaire (HCQ), EQ-5D and SF-6D in patients following arthroscopic partial meniscectomy surgery.     

Validation of the EQ-5D in a general population sample in urban China

Purpose  

To evaluate the reliability and validity of the EQ-5D in a general population sample in urban China.     

Psychometric evaluation of the Chinese version of the Child Health Utility 9D (CHU9D-CHN): a school-based study in China

Quality of Life Research - The Child Health Utility 9D (CHU9D), a new generic preference-based health-related quality of life (HRQoL) instrument, was developed specifically for the application in...     

A cross-sectional validation study of EQ-5D among the Malaysian adult population

Purpose  

The objective of this study was to assess the construct validity of the EQ-5D instrument among the Malaysian population.     

The comparative responsiveness of the EQ-5D and SF-6D to change in patients with inflammatory arthritis

Purpose  

Comparative evidence regarding the responsiveness of the EQ-5D and SF-6D in arthritis patients is conflicting and insufficient across the range of disease severity. We examined the comparative responsiveness of the EQ-5D and SF-6D in cohorts of patients with early inflammatory disease through to severe rheumatoid arthritis (RA).     

A comparison of the discriminative and evaluative properties of the SF-36 and the SF-6D index

Purpose  

To examine whether the move from the multidimensional SF-36 patient-reported outcome measure to the single-index preference-based SF-6D entails a loss in discriminative and evaluative properties, the magnitude of that loss and whether it matters.     

Nothing About Us Without Us? A Comparison of Adolescent and Adult Health‐State Values for the Child Health Utility‐9D Using Profile Case Best–Worst Scaling

The main objective of this study was to compare and contrast adolescent and adult values for the Child Health Utility‐9D (CHU9D), a new generic preference‐based measure of health‐related quality of life designed for application in the economic evaluation of treatment and preventive programmes for children and adolescents. Previous studies have indicated that there may be systematic differences in adolescent and adult values for identical health states. An online survey including a series of best–worst scaling discrete choice experiment questions for health states defined by the CHU9D was administered to two general population samples comprising adults and adolescents, respectively. The results highlight potentially important age‐related differences in the values attached to CHU9D dimensions. Adults, in general, placed less weight upon impairments in mental health (worried, sad, annoyed) and more weight upon moderate to severe levels of pain relative to adolescents. The source of values (adults or adolescents) has important implications for economic evaluation and may impact significantly upon healthcare policy. Copyright © 2015 John Wiley & Sons, Ltd.     

Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context

Background  

Multi-attribute utility measures are preference-based health-related quality of life measures that have been developed to inform economic evaluations of health care interventions. The objective of this study was to compare the empirical validity of two multi-attribute utility measures (EQ-5D and SF-6D) based on hypothetical preferences in a large maternity population in England.     

Comparing the sensitivity of EQ-5D, SF-6D and 15D utilities to the specific effect of diabetic complications

Objectives  

Diabetes patients suffer from comorbid conditions and disease-related complications. Combined with demographic, clinical and treatment satisfaction variables, they have a confounding effect on health-related quality of life (HRQoL). This study compared the sensitivity of EQ-5D, SF-6D and 15D utilities to the specific effect of diabetes complications.     

Measuring Weight-Specific Quality of Life in Adolescents: An Examination of the Concurrent Validity and Test-Retest Reliability of the WAItE

Objectives

To examine the concurrent validity of the Weight-specific Adolescent Instrument for Economic evaluation (WAItE) as compared with the generic, preference-based Child Health Utility 9D (CHU-9D) and the weight-specific Youth Quality of Life—Weight (YQOL-W) and also to examine the test-retest reliability of the WAItE.

Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics

Background  

For the treatment of depression in diabetes patients, it is important that depression is recognized at an early stage. A screening method for depression is the patient health questionnaire (PHQ-9). The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression in diabetes patients in outpatient clinics.     

Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

Purpose  

This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure.