PharmacoEconomics ( IF 4.4 ) Pub Date : 2024-01-27 , DOI: 10.1007/s40273-024-01356-0 Diana Khanna 1 , Jyoti Khadka 1, 2 , Christine Mpundu-Kaambwa 1 , Gang Chen 3 , Kim Dalziel 4, 5 , Nancy Devlin 4 , Julie Ratcliffe 1 ,
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Background
Self-reporting of health-related quality of life (HRQoL) in children is not always feasible. To date, proxy perspectives (Proxy versions 1 and 2) using the EQ-5D-Y-3L have not been explored for its impact on agreement with child self-report. Proxy version 1 requires the proxy to consider their own view of the child’s HRQoL (proxy-proxy), while with Proxy version 2, the proxy is asked to respond as they believe their child would self-report their HRQoL (proxy-child). This study compared the inter-rater and intra-proxy agreement (overall and dimension level) using the EQ-5D-Y-3L self, proxy-proxy, and proxy-child reports.
Methods
A community-based sample of child (aged 6–12 years) and parent dyads were invited to participate in a semi-structured interview. The child self-completed the EQ-5D-Y-3L independently of the parent who completed the EQ-5D-Y-3L from proxy-proxy and proxy-child perspectives. Agreement was determined using Concordance Correlation Coefficients (CCCs) for the overall (preference-weighted) HRQoL, while agreement at the dimension level was evaluated using Gwet’s agreement coefficient (AC1). To assess the differences between the self and the two proxy reports, the Wilcoxon matched-pair signed-rank test was used.
Results
This study involved 85 child-parent dyads. The agreement between self and proxy overall HRQoL was low (fair) with both proxy-proxy (CCC = 0.28) and proxy-child (CCC = 0.26) reports. The largest discrepancy in the child-proxy agreement at dimension level with both the proxy versions was observed for ‘feeling worried, sad or unhappy’. Within this dimension, the proxy-child perspective resulted in a stronger agreement (AC1 = 0.7, good) with child self-report compared with the traditional proxy-proxy perspective (AC1 = 0.58, moderate). Although the preference-weighted HRQoL was consistent across both the proxy perspectives, a significant difference was observed in the EQ VAS scores (p = 0.02).
Conclusions
This study demonstrates that choice of proxy perspective may have an impact on the problems reported on HRQoL dimensions and EQ VAS scores. However, in this community-based sample of generally healthy children, no significant difference was observed in the inter-rater agreement for child-self and proxy preference-weighted EQ-5D-Y-3L values based on proxy perspectives. While this suggests that preference-weighted data are not sensitive to the choice of perspective, these findings may differ for different HRQoL instruments and for alternative value sets with different properties.
中文翻译：
使用 EQ-5D-Y-3L 测量社区儿童生活质量的评估者间和代理内部协议的调查
背景
自我报告儿童健康相关生活质量 (HRQoL) 并不总是可行。迄今为止，尚未探讨使用 EQ-5D-Y-3L 的代理视角（代理版本 1 和 2）对儿童自我报告一致性的影响。代理版本 1 要求代理考虑他们自己对孩子的 HRQoL（代理-代理）的看法，而代理版本 2 则要求代理做出回应，因为他们相信他们的孩子会自我报告他们的 HRQoL（代理-孩子）。本研究使用 EQ-5D-Y-3L 自我、代理-代理和代理-儿童报告比较了评估者间和代理内部一致性（总体和维度水平）。
方法
基于社区的儿童（6-12 岁）和家长样本被邀请参加半结构化访谈。孩子独立于父母从代理-代理和代理-孩子的角度独立完成了 EQ-5D-Y-3L。使用总体（偏好加权）HRQoL 的一致性相关系数（CCC）确定一致性，而使用 Gwet 一致性系数（AC 1 ）评估维度水平的一致性。为了评估自我报告和两个代理报告之间的差异，使用了 Wilcoxon 配对符号秩检验。
结果
这项研究涉及 85 名子女-父母二人组。代理-代理 (CCC = 0.28) 和代理-儿童 (CCC = 0.26) 报告中，自我和代理总体 HRQoL 之间的一致性较低（一般）。观察到两个代理版本在维度级别的儿童代理协议中最大的差异是“感到担心、悲伤或不高兴”。在此维度内，与传统的代理-代理视角（AC 1 = 0.58，中等）相比，代理-儿童视角与儿童自我报告的一致性更强（AC 1 = 0.7，良好）。尽管偏好加权的 HRQoL 在两个代理视角中是一致的，但在 EQ VAS 评分中观察到显着差异 ( p = 0.02)。
结论
本研究表明，代理视角的选择可能会对 HRQoL 维度和 EQ VAS 分数报告的问题产生影响。然而，在这个基于社区的总体健康儿童样本中，基于代理视角的儿童自我和代理偏好加权 EQ-5D-Y-3L 值的评估者间一致性没有观察到显着差异。虽然这表明偏好加权数据对视角的选择不敏感，但对于不同的 HRQoL 工具和具有不同属性的替代值集，这些结果可能会有所不同。
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