Quality of Life Research

, Volume 28, Issue 1, pp 163–176 | Cite as

Scoring the Child Health Utility 9D instrument: estimation of a Chinese child and adolescent-specific tariff

  • Gang Chen
  • Fei XuEmail author
  • Elisabeth Huynh
  • Zhiyong Wang
  • Katherine Stevens
  • Julie Ratcliffe



To derive children and adolescents’ preferences for health states defined by the Chinese version of Child Health Utility 9D (CHU9D-CHN) instrument in China that can be used to estimate quality-adjusted life years (QALYs) for economic evaluation.


A profile case best–worst scaling (BWS) and a time trade-off (TTO) method were combined to derive a Chinese-specific tariff for the CHU9D-CHN. The BWS survey recruited students from primary and high schools using a multi-stage random sampling method and was administered in a classroom setting, whilst the TTO survey adopted an interviewer-administrated conventional TTO task and was administered to a convenience sample of undergraduate students. A latent class modelling framework was adopted for analysing the BWS data.


Two independent surveys were conducted in Nanjing, China, including a valid sample of 902 students (mean age 13 years) from the BWS survey and a valid sample of 38 students (mean age 18 years) from the TTO survey. The poolability of the best and the worst responses was rejected and the optimal result based on the best responses only. The optimal model suggests the existence of two latent classes. The BWS estimates were further re-anchored onto the QALY scale using the TTO generated health state values via a mapping approach.


This study provides further insights into the use of the BWS method to generate health state values with young people and highlights the potential different decision rules that young people may employ for determining best vs. worst choices in this context.


Child Health Utility 9D Quality-adjusted life years Economic evaluation Child Adolescent China 



The paper has benefited from participants at the International Society for Quality of Life Research (ISOQOL) 23rd Annual Conference. We are grateful to Chao Li, Qin Ye, Hairong Zhou, Zhenzhen Qin, Shenxiang Qi, Huafeng Yang, Xupeng Chen from Nanjing Municipal CDC for their assistants with data collection. Responsibility for any remaining errors lies solely with the authors.


The study was supported by the Nanjing Municipal Science and Technique Foundation (ZDX12019), China.

Compliance with Ethical Standards

Conflict of interest

KS is the developer of the CHU9D and took a small royalty in 2016 for a commercial licence. All other authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was reviewed and approved by the academic and ethical committee of Nanjing Municipal Center for Disease Control and Prevention. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

All participants to both surveys provided written consent prior to participation.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Centre for Health Economics, Monash Business SchoolMonash UniversityClaytonAustralia
  2. 2.Nanjing Municipal Center for Disease Control and PreventionNanjingChina
  3. 3.School of Public HealthNanjing Medical UniversityNanjingChina
  4. 4.Institute for ChoiceUniversity of South AustraliaAdelaideAustralia
  5. 5.Health Economics and Decision Science, ScHARRUniversity of SheffieldSheffieldUK

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