Practicality, Validity, and Responsiveness of Using the Proxy Version of the Child Health Utility-9 Dimensions With Children Aged 2 to 5 Years

Tracey H Sach; Hywel C Williams; BEEP Study Team

doi:10.1016/j.jval.2024.08.010

Practicality, Validity, and Responsiveness of Using the Proxy Version of the Child Health Utility-9 Dimensions With Children Aged 2 to 5 Years

Value Health. 2024 Oct 10:S1098-3015(24)02861-4. doi: 10.1016/j.jval.2024.08.010. Online ahead of print.

Authors

Tracey H Sach¹, Hywel C Williams²; BEEP Study Team

Collaborators

BEEP Study Team:
Hilary Allen³, Robert Boyle³, Maeve Kelleher³, Sara Brown⁴, Mike Cork⁵, Carsten Flohr⁶, Nicola Jay⁷, Stella Lartey⁸, Charlotte Davies⁸, Sandra Lawton⁹, Michael Perkin¹⁰, Matthew Ridd¹¹, Tracey Sach¹², Joanne Brooks¹³, Stella Tarr¹⁴, Laura Wyatt¹⁴, Kim Thomas¹⁵

Affiliations

¹ School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, UK; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, England, UK. Electronic address: t.sach@soton.ac.uk.
² Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, England, UK.
³ National Heart and Lung Institute, Imperial College London, London, UK.
⁴ Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Scotland, UK.
⁵ Sheffield Dermatology Research, Department of Infection and Immunity, University of Sheffield, Sheffield, UK.
⁶ Unit for Paediatric & Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, UK.
⁷ Sheffield Children's Hospital, Sheffield, UK.
⁸ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
⁹ Rotherham NHS Foundation Trust, UK.
¹⁰ Population Health Research Institute, St. George's, University of London, London, UK.
¹¹ Population Health Sciences, University of Bristol, Bristol, UK.
¹² School of Primary Care, Population Sciences and Medical Education, University of Southampton, UK; Health Economics Group, University of East Anglia, UK.
¹³ Rachel Haines, Eleanor Mitchell, Alan Montgomery, Richard Swinden.
¹⁴ Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.
¹⁵ Hywel Williams, Joanne Chalmers, and Susan Davies-Jones, Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.

PMID: 39393565
DOI: 10.1016/j.jval.2024.08.010

Abstract

Objectives: This study aimed to assess the practicality, validity, and responsiveness of the proxy Child Health Utility-9 Dimensions (CHU9D) in children aged 2 to 5 years.

Methods: We used data from the Barrier Enhancement for Eczema Prevention trial, a UK randomized controlled trial testing whether daily emollients in infancy could prevent eczema in high-risk infants. The main parent/carer completed the proxy CHU9D using developers' additional guidance for completion in those younger than 5 years and the Patient-Oriented Eczema Measure (POEM) at ages 2, 3, 4, and 5 years. Practicality was assessed by completion rates. Construct validity assessed whether CHU9D could discriminate between those with/without eczema and between eczema severity levels on POEM. Responsiveness was determined by ability to discriminate between 3 groups: (1) those whose POEM score deteriorated ≥3 points, (2) those whose change was not clinically important (-2.9 to 2.9 points), and (3) those whose POEM score improved ≥3 points. Analysis was conducted in Stata 17.

Results: Of 1394 children participating in the Barrier Enhancement for Eczema Prevention trial, study questionnaires were completed by 1212 (87%), 981 (70%), 990 (71%), and 976 (70%) at 2, 3, 4, and 5 years. Of these the CHU9D was completed by 1066 (88.0%), 685 (69.8%), 925 (93.4%), and 923 (94.6%), respectively. Mean utility at all time points was approximately 0.934 (range 0.443-1). For construct validity, very small differences in the CHU9D between known groups were observed (P < .01). A total of 801 participants had responsiveness data: 13% deteriorated, 72% had nonclinically important change, and 15% improved. Mean utility change (standardized response mean) for these groups was -0.0198 (0.21), 0.0041 (0.05), and 0.0175 (0.21) showing small change and small responsiveness.

Conclusions: Proxy CHU9D in 2- to 5-year-old children shows potential but further research is needed.

Keywords: CHU9D; pediatric; proxy; psychometric properties.