Developing accessible, pictorial versions of health-related quality of life instruments suitable for economic evaluation: a report of preliminary studies conducted in Canada and the United Kingdom

A key component of the current framework for economic evaluation is the measurement and valuation of health outcomes using generic preference-based health-related quality of life (HRQoL) instruments. In 2015, a research synthesis reported the absence of conceptual and empirical research regarding the appropriateness of current preference-based instruments for people with aphasia – a disorder affecting the use and understanding of language – and suggested the development and validation of an accessible, pictorial variant could be an appropriate direction for further research. This paper describes the respective rationale and development process for each of three preliminary studies that have been undertaken to develop pictorial variants of two widely-used preference-based HRQoL instruments (EQ-5D-3L and EQ-5D-5L). The paper also proposes next steps for this program of research, drawing on the lessons learned from the preliminary work and the demand for a pictorial preference-based instrument in the research community. Guidance for the use of the preliminary, pictorial instruments is also provided.