Methodological Insights from Health Valuation Studies in Low- and Middle-Income Countries: A Scoping Review.

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 grey 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: Thirty-six 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. Thirty-three studies developed nationally representative value sets, two of which were based on patient preferences. Two pilot studies and one cancer-specific value set were also included. The EQ-5D-5L was used most (n=16), followed by the EQ-5D-3L (n=14), SF-6D (n=4), CQ-11D (n=1) and EORTC-8D (n=1). Methodological adaptions included 'lite' protocols, portable tools, and crosswalk methodology. Comprehension aids were reported in 11 studies; five included illiterate participants, and seven were conducted in multiple languages.

Conclusion: Valuation studies are increasing rapidly in LMICs and there is growing experimentation to reduce resource demands and enhance inclusivity. While this is promising, the resource demands of valuation studies still limit their implementation in low-income settings. As a result, countries may still find it more cost-efficient to adapt value sets from neighbouring countries rather than develop their own.