Comparative evaluation of the health utilities index mark 3 and the short form 6D: evidence from an individual participant data meta-analysis of very preterm and very low birthweight adults

Abstract

Background The most appropriate preference-based health-related quality of life (HRQoL) instruments for trials or research studies that ascertain the consequences of individuals born very preterm and/or low birthweight (VP/VLBW) are not known. Agreement between the HUI3 and SF-6D multi-attribute utility measures have not been previously investigated for VP/VLBW and normal birthweight or term-born controls. This study examined the agreement between the outputs of the HUI3 and SF-6D measures among adults born VP/VLBW and normal birthweight or term born controls. Methods We used two prospective cohorts of individuals born VP/VLBW and controls contributing to the ‘Research on European Children and Adults Born Preterm’ (RECAP) consortium which assessed HRQoL using two preference-based measures. The combined dataset of individual participant data (IPD) included 407 adult VP/VLBW survivors and 367 controls, ranging in age from 18 to 26 years. Bland–Altman plots, intra-class correlation coefficients, and generalized linear mixed models in a one-step approach were used to examine agreement between the measures. Results There was significant discordance between the HUI3 and SF-6D multi-attribute utility measures in the VP/VLBW sample, controls, and in the combined samples. Agreement between the HUI3 and SF-6D multi-attribute utility measures was weaker in controls compared with VP/VLBW individuals. Conclusions and relevance The HUI3 and SF-6D each provide unique information on different aspects of health status across the groups. The HUI3 better captures preterm-related changes to HRQoL in adulthood compared to SF-6D. Studies focused on measuring physical or cognitive aspects of health will likely benefit from using the HUI3 instead of the SF-6D, regardless of gestational age at birth and birthweight status.

Psychometric Performance of Generic Childhood Multi-Attribute Utility Instruments in Preterm and Low Birthweight Populations: A Systematic Review

“…Eight studies were judged by the review authors as having a direct aim of assessing the psychometric performance of MAUI(s) [43,[68][69][70][71][72][73][74]. Bolbocean and colleagues [68] compared the relative performances of the HUI3 and adult-specific SF-6D in capturing health utility differences between PLB and full-term/normal birthweight groups.…”

“…Eight studies were judged by the review authors as having a direct aim of assessing the psychometric performance of MAUI(s) [43,[68][69][70][71][72][73][74]. Bolbocean and colleagues [68] compared the relative performances of the HUI3 and adult-specific SF-6D in capturing health utility differences between PLB and full-term/normal birthweight groups. Feeny and colleagues [69] assessed the agreement between the HUI2/3 utility scores generated by the application of an available value set and health utility directly measured using a standard gamble.…”

“…The sole exception was the study by Roberts and colleagues (2013) [59], which expected similar HRQoL between controls and EP/ELBW adults born in Australia prior to the introduction of surfactants. Twelve studies did not clearly state their a priori hypothesis and were assumed to have expected lower HRQoL for the PLB group relative to controls [64,68,69,71,75,76,82,83,87,[92][93][94]. Several studies tested hypotheses on subgroup differences in HRQoL within the PLB population [77,[79][80][81]85,86,[88][89][90]96,99]: e.g., between extremely preterm subgroups with and without a neurodevelopmental disability [89].…”

“…Agreements between the standard gamble utility and HUI3 utility scores were low at both group and individual levels (output '−'). Bolbocean and colleagues [68] found low agreement between HUI3 and SF-6D utility scores at group and individual levels (output '−').…”

“…Twelve studies assessed acceptability but only concerning one criterion (e.g., missing data rate), which meant that their assessments (n = 15) received the output '?' [59,61,[67][68][69]75,78,[81][82][83]96,97]. Another 12 studies assessed multiple criteria [43,62,64,71,72,77,86,90,[93][94][95]99].…”