Psychometric Performance of Preference-Weighted Instruments in Older Adults: A Systematic Review

Lidia Engel; Valeriia Sokolova; Jan Faller; Yared Belete Belay; Pei Wang; Jan Abel Olsen; Brendan Mulhern

doi:10.1016/j.jval.2026.03.2234

Psychometric Performance of Preference-Weighted Instruments in Older Adults: A Systematic Review

Value Health. 2026 Apr 8:S1098-3015(26)02376-4. doi: 10.1016/j.jval.2026.03.2234. Online ahead of print.

Authors

Lidia Engel¹, Valeriia Sokolova², Jan Faller², Yared Belete Belay², Pei Wang², Jan Abel Olsen³, Brendan Mulhern⁴

Affiliations

¹ School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia. Electronic address: lidia.engel@monash.edu.
² School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
³ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁴ Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, New South Wales, Australia.

PMID: 41962836
DOI: 10.1016/j.jval.2026.03.2234

Abstract

Objectives: Population aging is a major public health concern. Preference-weighted instruments are widely used to assess health-related quality of life 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, and 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 Consensus-Based Standards for the Selection of Health Measurement Instrument risk of bias checklist, and evidence was graded using a modified GRADE approach.

Results: A total of 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, although ceiling effects, limited interrater reliability, and 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. Although interrater 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 because of limited assessment of responsiveness, few head-to-head comparisons, and lack of age-group-specific analyses.

Keywords: aging; economic evaluation; preference-weighted measures; psychometrics; quality of life.

Publication types

Review