Psychometric performance of preference-weighted instruments in older adults: a systematic review

BACKGROUND: Population ageing is a major public health concern. Preference-weighted instruments are widely used to assess health-related quality of life (HRQoL) and inform cost-effectiveness analyses. Given the range of available measures, it is important to identify those most suitable for older adults. This study systematically reviewed evidence on the psychometric properties of preference-weighted measures in older adults. METHODS: Four databases (Medline, Embase, PsycINFO, CINAHL) were searched, supplemented by citation tracking. Peer-reviewed studies assessing the psychometric properties of preference-weighted measures in adults aged ≥60 were included. Two reviewers independently screened and extracted data. Methodological quality was assessed using the COSMIN risk of bias checklist, and evidence was graded using a modified GRADE approach. RESULTS: 106 studies were included, covering EQ-5D-3L (4), EQ-5D-5L (34), ICECAP-O (29), ASCOT (15), QOL-ACC (9), HUI3 (8), HUI2 (7), QWB (5), EQ-HWB-9 (5), WOOP (3), SF-6D (3), AQoL-8D (2), AQoL-4D (1), and 15D (1). EQ-5D versions showed acceptable performance on some criteria, though ceiling effects, limited inter-rater reliability, inconsistent responsiveness were reported. ICECAP-O and ASCOT showed more consistent evidence, but both need further testing on responsiveness. Limited and mixed findings were available for other measures. Early evidence for QOL-ACC and WOOP was promising but incomplete. While inter-rater reliability and responsiveness evidence remained limited across all measures, specific measures performed generally better than generic measures but had fewer studies. CONCLUSIONS: Preference-weighted measures are widely used with older adults, but psychometric evidence remains incomplete due to limited assessment of responsiveness, few head-to-head comparisons, and lack of age-group-specific analyses.