A systematic review of utility values in children with cerebral palsy

Qual Life Res. 2019 Jan;28(1):1-12. doi: 10.1007/s11136-018-1955-8. Epub 2018 Aug 2.


Purpose: Project aims include the following: (i) to identify reported utility values associated with CP in children aged ≤ 18 years; (ii) to explore utility value elicitation techniques in published studies; and (iii) to examine performance of the measures and/or elicitation approaches.

Methods: Peer-reviewed studies published prior to March 2017 were identified from six electronic databases. Construct validity, convergent validity, responsiveness, and reliability of instruments were assessed.

Results: Five studies met the inclusion criteria. Utility values of hypothetical general CP states obtained from a general population of parents ranged from 0.55 to 0.88 using time trade off (TTO) and 0.60-0.87 using standard gamble (SG) techniques. Utility values reported by clinicians of three hypothetical spastic quadriplegic CP states, using the Health Utility Index Mark 2 (HUI-2), ranged from 0.40 to 0.13. Other sources of utilities identified were based on both proxy and child ratings using Health Utility Index Mark 3 (HUI-3) (values ranged from - 0.013 to 0.84 depending on the valuation source) and the Assessment of Quality of Life 4 Dimension instrument, with values ranging from 0.01 to 0.58. Construct validity of the HUI-3 varied from moderate to strong, whereas mixed results were found for convergent validity. Responsiveness and reliability were not reported.

Conclusion: There was substantial variation in reported utilities. Indirect techniques (i.e. via multi-attribute utility instruments) were more frequently used than direct techniques (e.g. TTO, SG). Further research is required to improve the robustness of utility valuation of health-related quality of life in children with CP for use in economic evaluation.

Keywords: Adolescent; Cerebral palsy; Children; Quality of life; Quality-adjusted life years; Utility value; Utility weight.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Cerebral Palsy / psychology*
  • Female
  • Humans
  • Male
  • Quality of Life / psychology*
  • Reproducibility of Results
  • Young Adult