Methodological insights from health valuation studies in low- and middle-income countries : a scoping review

Abstract

OBJECTIVES : Valuation studies generate utility values for health states using stated preference methods. These studies are complex and resource-intensive, posing implementation challenges in low- and middle-income countries (LMICs). This review aimed to examine how valuation studies in LMICs have navigated these challenges. METHODS : A scoping review was conducted, with database (MEDLINE, EMBASE, and CINAHL) and gray literature searches performed between April and June 2024. Inclusion was limited to valuation studies in LMICs using generic or disease-specific instruments and stated preference techniques with adult respondents and published in English. Results were narratively synthesized. RESULTS : A total of 36 studies from 22 LMICs were included. Studies were conducted across low (n = 2), lower-middle (n = 11), and upper middle-income countries (n = 9). Half were published since 2020. There were 33 studies that developed nationally representative value sets, 2 of which were based on patient preferences. Two pilot studies and 1 cancer-specific value set were also included. The EQ-5D-5L was used most (n = 16), followed by the EQ-5D-3L (n = 14), Short Form-6 Dimension (n = 4), Chinese medicine Quality of life-11 Dimensions (n = 1), and European Organization for Research and Treatment of Cancer-8 dimension (n = 1). Methodological adaptations included “lite” protocols, portable tools, and crosswalk methodology. Comprehension aids were reported in 11 studies; 5 included illiterate participants, and 7 were conducted in multiple languages. CONCLUSIONS : Valuation studies are increasing rapidly in LMICs, and there is growing experimentation to reduce resource demands and enhance inclusivity. Although this is promising, the resource demands of valuation studies still limit their implementation in low-income settings. Therefore, these countries may still find it more cost-efficient to adapt value sets from neighboring countries rather than develop their own.

HIGHLIGHTS • This review examines the use of strategies to reduce the resource demands and inclusivity of valuation studies in low- and middle-income countries. • Valuation studies have increased rapidly in low- and middle-income countries, and strategies are evolving to reduce resource burden (eg, “lite” protocols) and increase inclusivity. Nevertheless, the limited number of studies in low-income countries suggests that resource requirements remain a barrier. • Although further validation is needed, these emerging strategies have the potential to reduce entry costs for countries to conduct valuation studies and enable more inclusive, representative sampling.