Determining health-related quality of life among children with malaria in Kenya: does the choice of EQ-5D value set matter?

TL;DR

This study examines how different value sets affect quality of life estimates for children with malaria in Kenya, showing significant differences depending on the set used.

Contribution

The study demonstrates that the choice of EQ-5D value set significantly impacts utility estimates for malaria in Kenyan children.

Findings

The most affected HRQoL domains in children with malaria were pain/discomfort and usual activity.

Utility scores varied significantly across Ethiopian, Ugandan, and Dutch value sets for both uncomplicated and severe malaria cases.

Vaccination status and malaria severity were significant determinants of utility scores.

Abstract

Malaria remains a major public health issue, especially for children under five, yet health-related quality of life (HRQoL) data needed for cost-effectiveness analyses are limited. This study assesses malaria’s impact in Kenyan children and examine how different EQ-5D value sets affect utility estimates.

A cross-sectional study was conducted in western Kenya. From June to September 2024, caregivers completed the proxy-reported EQ-5D-5L questionnaire. In the absence of a Kenyan value set, utility scores were estimated using both Ethiopian, Ugandan, and Dutch value sets. Differences across value sets were assessed using the Friedman test, while factors associated with utility scores were identified using Tobit regression.

Of the 95 children studied, 45 had uncomplicated malaria and 50 had severe malaria. The most affected EQ-5D-5L domains were pain/discomfort and usual activity. For uncomplicated malaria, the median (interquartile) utility scores were 0.82 (0.86) using the Ethiopian value set, 0.59 (1.29) using the Ugandan value set, and 0.73 (0.98) using the Dutch value set. For severe malaria, the median (interquartile) utility scores were lower: 0.30 (1.21) for the Ethiopian, -0.13 (1.44) for the Ugandan, and 0.09 (0.96) for the Dutch value sets, respectively. The differences across these value sets were statistically significant. Vaccination status and severity of malaria were found to be significant determinants of utility scores.

Malaria considerably reduces children’s HRQoL. The choice of value set has a significant influence on utility estimates, potentially affecting the cost-effectiveness analyses of malaria interventions. These findings underscore the need for Kenyan-specific value set to reflect preference of the population.