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UBC Theses and Dissertations

Deriving health utility weights for infants with Respiratory Syncytial Virus (RSV) Roy, Lilla MC


Background: RSV infects the majority of infants under one year, and is a leading cause of bronchiolitis-related hospitalization, incurring significant cost on the health care system. Economic evaluation guidelines require the use of quality-adjusted life years (QALYs) – a single measure of health outcome that incorporates both quality of life and length of life; however, there is no established standard for eliciting health utilities in children. Measuring utility in infant RSV presents significant methodological challenges related to proxy response, perspective of the elicitation task, and the temporary nature of the health condition combined with potential long-term outcomes. Objectives: The objectives of this thesis were to: 1) review the methodological literature surrounding infant utility derivation using a proxy respondent and in temporary health states; 2) derive the health utility for different severities of Respiratory Syncytial Virus (RSV) infection; and 3) determine relative preferences of health state attributes for RSV in infants. Methods: Using results from a literature review and qualitative study, time trade-off (TTO) and best-worst scaling (BWS) experiments were constructed reflecting four RSV severity levels, using two perspectives – child and adult. Administered online, respondents randomly received either a questionnaire from either the adult or child perspective, completing both TTO and BWS tasks, allowing elicitation and comparison of both health state utilities and relative preferences for health state attributes from two perspectives Results: Respondents were willing to trade off more time to avoid more severe health states, indicating greater disutility associated with severe RSV, and suggests respondents understood the task. Responses differed between the adult and child perspectives, with disutilities from the child perspective being slightly greater. BWS revealed that respondents most often chose breathing failure as the worst attribute and 0% risk of wheeze as the best from both perspectives. Conclusion: Responses differ between adult and child perspectives. This is the first study known to explore utilities for RSV in infants, and can be utilized for the further utility research and economic evaluation of any current or potential treatment for RSV, or other temporary health states in infants.

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