A Comparative Study Of EQ-5D-Y And CHU-9D In Measuring The Health Utility Of Children With Allergic Rhinitis

Objective:To evaluate the applicability of the EQ-5D-Y and CHU-9D in pediatric with AR aged 7 to 17 years old,and to explore the main factors affecting the patients’health utility.The research would provide the method reference and basic data support for carrying out cost-utility analysis in the future.Methods:Pediatric with AR who met the inclusion and exclusion criteria in Our Outpatient Department of Otolaryngology were included in the field questionnaire survey from May 2019 to January 2020.The contents of the survey included the patients’socio-demographic information,clinical disease information and health utility scale.The validity,reactivity,and consistency of measurement results of EQ-5D-Y and CHU-9D instruments were compared to evaluate the applicability of the two in children with AR in China.ICC and Bland-Altman plot were used to verify the consistency of the utility values between EQ-5D-Y and CHU-9D.The investigation of validity included discriminant validity and convergent validity.The area under the ROC and Spearman rank correlation analysis were used to evaluate the validity.Reactivity was mainly measured by the relative efficiency and sensitivity of the scale to the differences in clinical characteristics.Finally,with EQ-5D-Y and CHU-9D index scores as the dependent variable,sociodemographic characteristics(gender,age,education level,place of residence)and clinical characteristics(course of disease,skin index,family history of allergic disease,the scores of each dimension in RQLQ)as the independent variable,regression analysis of influencing factors of patients’health utility was conducted.Results:312 valid questionnaires were collected and the effective response rate was 94.83%.The mean health utility of EQ-5D-Y and CHU-9D were 0.81±0.15(95%CI:0.80 to 0.83)and 0.84±0.13(95%CI:0.83 to 0.86)respectively.The ICC was 0.696(95%CI:0.615 to 0.759),and the 95%limits of agreement interval was-0.18 to 0.24,so the measurement results were not consistent.The area under the ROC curve of the health utility value measured by EQ-5D-Y and CHU-9D in pediatric with mild and moderate to severe AR was 0.667 and 0.779,respectively.They had moderate judgment power for patients with different degrees of severity,and CHU-9D had better discriminative validity.A total of 8 in the 12 prior hypothesis groups had medium to strong correlation(0.422≤Spearman rank correlation coefficient≤0.690,P<0.05),which showed moderate aggregation validity.The ceiling effect of EQ-5D-Y and CHU-9D was26.60%and 17.63%respectively,and no floor effect appeared.Both instruments had well sensitivity to the dimensions of RQLQ except ocular symptoms.CHU-9D was more sensitive in sleep,non-nasal/ocular symptoms and emotional function than EQ-5D-Y,and the sensitivity of the two was similar in nasal symptoms or practical problems.The R~2of EQ-5D-Y ridge regression model was 0.297(F=8.974,P<0.001),and the R~2of CHU-9D ridge regression model was 0.416(F=15.111,P<0.001).Emotional function,sleep status,non-nasal/ocular symptoms,practical problems,nasal symptoms,family history of allergic diseases and course were important factors affecting the health utility of pediatric with AR.Conclusion:Both EQ-5D-Y and CHU-9D had great applicability in pediatric with AR,but their measurement results were inconsistent and couldn’t be exchanged.CHU-9D as a health utility instrument was more suitable for Chinese children with AR.Emotional function,sleep status,non-nasal/ocular symptoms,practical problems,nasal symptoms,family history of allergic diseases and course were important factors affecting the health utility of children with AR.Therefore,in addition to standard disease treatment,pediatric with AR should also pay attention to counseling negative emotion,improving sleep quality,and increasing the knowledge of disease health care,so as to achieve the purpose of improving the quality of life.