Thematic framework.

Objectives
Standard economic evaluation methods assume that quality-adjusted life years (QALYs) have equal social value, regardless of recipient. However, evidence suggests that people place greater social value on health gains for children. This study examines the factors driving age-related preferences for health gains.
Methods
Think-aloud, semi-structured interviews were conducted with Australian adolescents (n = 7), non-parents (n = 11), parents with healthy children (n = 8) and parents of children with health conditions (n = 15) over a period of four months (27th March 2023–20th July 2023). Participants completed Person Trade-Off (PTO) and attitudinal questions about resource allocation for improvements in life extension, mental health, mobility, and pain/discomfort choosing between interventions for adults (ages 40 or 55) and younger people (ages one month to 24). Thematic analysis was employed to identify fundamental reasoning patterns.
Results
Nine themes emerged, illustrating participants’ complex reasoning. They considered differences in the impact of health problems at various ages, with difficulty envisaging mental health impacts for very young children. Emotional responses were strongest around children in pain. Adolescents tended to prioritize younger people, while parents often emphasized adults’ caregiving role. Most participants prioritized based on age in PTO questions, though some adults objected to prioritizing healthcare based on age.
Conclusion
Choices were shaped by perceptions of the impact of the health states. These qualitative insights help to inform the development of different approaches in healthcare resource allocation highlighting the importance of involving a diverse range of participants with varying views in the decision-making process. The findings also provide insight into interpreting quantitative results from PTO tasks.