Exploration of the Reasons Why Health State Valuation Differs for Children Compared With Adults: A Mixed Methods Approach

Evidence comparing utilities for adults and children consistently report higher utility values for child health states. This study investigates the reasons why child health states are valued differently. A total of 80 respondents (United Kingdom, Belgium, The Netherlands) participated in 1.5-hour face-to-face interviews. Respondents valued 4 health states from 2 perspectives (8-year-old child, 40-year-old adult) using visual analog scale and time trade-off. A total of 32 respondents participated in think-aloud interviews. Audio recordings were analyzed by 2 independent coders using NVIVO software. Statements, nodes, and themes were reviewed cyclically until consensus was reached. Qualitative results: a total of 5 themes were identified in the data regarding child and adult valuation—intergenerational responsibility and dependency (childhood is crucial for forming life skills based on new experiences; adulthood is an important time to take care of the family), staying alive is important (life is worth living even with impaired health-related quality of life (HRQoL), for children and adults), awareness of poor HRQoL and ability to make decisions (children have difficulties comprehending poor HRQoL and their parents make their healthcare decision; adults can assess their own HRQoL and decide for themselves), coping ability (children are flexible and resilient; adults have experience with dealing with difficulties), and practical organization of care (children are cared for by their parents; adults are able to organize and pay for care). Mixed methods: comparing qualitative statements with respondents’ higher utilities for child health states confirmed concordance between results. Quality-adjusted life-years are interpreted differently for children and adults. Child-specific value sets are needed to reflect society’s preferences and to adequately conduct health technology assessment of pediatric treatments. •Fewer life-years are traded against a higher quality of life for health states referring to children than for adults by adult respondents, resulting in higher utility values for children using standard time trade-off methodologies.•Intergenerational responsibility and dependency are key in understanding society’s preferences for child health states.•Child-specific value sets are needed to correctly reflect society’s preferences for child health states, which are different from preferences for adult health states. It was found that the quality-adjusted life