Engaging experts on valuation of toddler and infant health: the case of EQ-TIPS

Valuing health-related quality of life (HRQoL) in children aged 0–4 years presents major methodological and normative challenges, as children cannot be directly involved and standard approaches to adults’ valuation of adult and older children’s health states may be inappropriate. In order to inform decisions on how to value HRQoL in children aged 0–4 years, this study explored the views of academic and HTA experts, as end users of this evidence, on the methodological and normative challenges involved, using the EuroQol Toddler and Infant Populations (EQ-TIPS) instrument as a case study. Two online focus groups were conducted: one with eight academic experts in health economics and valuation, and one with six health technology assessment (HTA) experts. Participants reviewed preparatory materials, including the EQ-TIPS EV3.0 questionnaire. Semi-structured discussions focused on four topics: age-specific values for EQ-TIPS versus mapping; choice of respondents; treatment of caregiver spillover effects and long-term consequences; and valuation and anchoring methods. Discussions were recorded, anonymized, summarized, and reviewed by participants. Views differed within and between groups. Academic experts were divided between supporting age-specific values for EQ-TIPS and favoring mapping to value sets for older children due to conceptual and feasibility concerns. In contrast, HTA experts questioned the need for a standalone EQ-TIPS value set, preferring consistency of values across pediatric age groups and viewing mapping as pragmatic. No consensus emerged on appropriate respondents, though both groups highlighted the need for empirical evidence comparing the preferences of general population adults and caregivers. The potential consideration of caregiver and future health impact in valuation of EQ-TIPS was widely acknowledged but contentious, and anchoring methods remained unresolved, with HTA experts favoring discrete choice experiments with mapping and academics experts calling for further research. Valuing HRQoL in infants and toddlers involves unresolved methodological challenges. HTA experts considered mapped values to be acceptable and appropriate. Further research is required both to establish the feasibility of mapping EQ-TIPS to EQ-5D-Y; to explore methods for valuing EQ-TIPS, and to test whether values differ between parents/caregivers and other adults.