PERSPECTIVES IN UTILITY ESTIMATION OF VESICOURETERAL REFLUX - CHILD, PARENT, OR DYAD?

Purpose: Because pediatric health conditions often involve both children and caregivers, pediatric utility estimation is often complicated by concerns over the appropriate viewpoint. Specifically, it is not clear whether the parents, the affected child, or both should be used as the basis for utility estimation.  Elicitation from these different health states could significantly impact the utility estimates, but to our knowledge these states have not been well-described. We therefore sought to estimate the utility of a common pediatric condition, vesicoureteral reflux (VUR), from various perspectives through an online tool.

Method: A time-trade-off (TTO) elicitation instrument was published through an online work interface, Amazon’s Mechanical Turk (mTurk).  Responders were randomly selected to answer questions from three perspectives (child, parent, or dyad) on the utility of a single VUR health state in an affected 6-year-old child.  Paralysis was incorporated in the survey as a warm-up exercise and as a utility reference. VUR utility estimates were log-transformed and a generalized linear model was used to determine what factors most impacted utility estimates.

Result: In total, we obtained 916 responses from mTurk with 43 incomplete surveys (5% dropout).  The mean age of respondents was 34 years; 47% were female.  A plurality (299, 33%) were currently married, and 340 (39%) had children.  We randomly assigned 307 to the child perspective, 284 were to the parent perspective, and 282 to the combined parent-child dyad perspective. VUR utilities were 0.97, 0.95, and 0.93 (p<0.001) in the child, dyad, and parent groups, respectively. After adjusting for prior cost-utility analysis knowledge, personal urinary tract infection (UTI) history, income, and race, VUR utility was significantly affected by the perspective, respondent marriage status and respondent age. VUR utility was higher in the child group (4% lower in parent vs child, p<0.001; 1% lower in dyad vs child, p<0.001), among single respondents (1% lower in married vs single, p=0.006), and among older respondents (0.4% increment per 10-year, p=0.008).

Conclusion: The utility of VUR in children is consistently highest when a child perspective is used and lowest when a parent perspective is used for elicitation.  A combined parent-child dyad consistently provides a mid-range value between these two extremes.  These findings could have significant implications for future utility elicitations in other pediatric conditions and further research is warranted to confirm these data.