How consistent are health utility values

Value in Health, 2012

Purpose: This review examines generic preference based measures and their ability to reflect health related quality of life in patients with visual disorders. Methods: A systematic search was undertaken to identify clinical studies of patients with visual disorders where health state utility values (HSUVs) were measured and reported. Data were extracted to assess the validity and responsiveness of the measures. A narrative synthesis of the data was undertaken due to the heterogeneity between different studies. Results: There was considerable heterogeneity in the 31 studies identified in terms of patient characteristics, visual disorders and outcomes reported. Vision loss was associated with a reduction in scores across the preference-based measure, but the evidence on validity and responsiveness was mixed. The EQ-5D's performance differed according to condition, with poor performance in age-related macular degeneration and diabetic retinopathy. The more limited evidence on the HUI-3 found it performed best in differentiating between severity groups of patients with glaucoma, AMD, cataracts and diabetic retinopathy. One study reported data on the SF-6D and showed it was able to differentiate between patients with AMD. Conclusion: The performance of the EQ-5D in visual disorders was mixed. The HUI-3 seemed to perform better in some conditions, but the evidence on this and SF-6D is limited. More head to head comparisons of these three measures are required. The new 5-level version of EQ-5D may do better at the milder end of visual function and there is research being undertaken into adding a vision relevant dimension.

Quality of Life Research, 2005

Background: The SF-6D and EQ-5D are both preference-based measures of health. Empirical work is required to determine what the smallest change is in utility scores that can be regarded as important and whether this change in utility value is constant across measures and conditions. Objectives: To use distribution and anchor-based methods to determine and compare the minimally important difference (MID) for the SF-6D and EQ-5D for various datasets. Methods: The SF-6D is scored on a 0.29-1.00 scale and the EQ-5D on a)0.59-1.00 scale, with a score of 1.00 on both, indicating 'full health'. Patients were followed for a period of time, then asked, using question 2 of the SF-36 as our anchor, if their general health is much better (5), somewhat better (4), stayed the same (3), somewhat worse (2) or much worse (1) compared to the last time they were assessed. We considered patients whose global rating score was 4 or 2 as having experienced some change equivalent to the MID. This paper describes and compares the MID and standardised response mean (SRM) for the SF-6D and EQ-5D from eight longitudinal studies in 11 patient groups that used both instruments. Results: From the 11 reviewed studies, the MID for the SF-6D ranged from 0.011 to 0.097, mean 0.041. The corresponding SRMs ranged from 0.12 to 0.87, mean 0.39 and were mainly in the 'small to moderate' range using Cohen's criteria, supporting the MID results. The mean MID for the EQ-5D was 0.074 (range-0.011-0.140) and the SRMs ranged from)0.05 to 0.43, mean 0.24. The mean MID for the EQ-5D was almost double that of the mean MID for the SF-6D. Conclusions: There is evidence that the MID for these two utility measures are not equal and differ in absolute values. The EQ-5D scale has approximately twice the range of the SF-6D scale. Therefore, the estimates of the MID for each scale appear to be proportionally equivalent in the context of the range of utility scores for each scale. Further empirical work is required to see whether or not this holds true for other utility measures, patient groups and populations.

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2000

The relationship between health-related quality of life (HQL) measures and patient preference for their health status was studied. Study subjects consisted of 132 patients at four hospitals who were scheduled for cataract surgery. Generic and disease-specific health status measures were determined in study subjects. The Medical Outcomes Study Short-form 36 (SF-36) item health status instrument was used to measure generic health status and the Visual Function 14 (VF-14) item visual health status instrument was used as the disease-specific health measure. Preference for general health and visual health was measured by assessing utilities assigned by patients to certain health states. Utilities assigned for general health were correlated with all categories of the SF-36 and VF-14 scores. Utilities assigned for visual health were correlated with four categories of the SF-36 (role limitation due to emotional health, general health, physical functioning, and vitality) and VF-14 scores. Ut...

2011

Utility weights for the vision related Assessment of Quality of Life (AQoL)-7D instrument ABSTRACT Purpose: To obtain utility weights consistent with the needs of economic evaluation for the Assessment of Quality of Life (AQoL)-7D, a generic instrument created to increase the sensitivity of the measurement of quality of life amongst people with impaired vision.

Journal of Clinical Epidemiology, 2003

Four generic, preference-weighted, health-related quality of life (HRQL) questionnaires (the Quality of Well-Being, the Health Utilities Index, the EQ-5D, and the SF-6D) are reviewed. Although all of these questionnaires are designed to measure the same concept, each uses a different model of health, a different method of deriving preferences, and a different scoring formula. Head-to-head comparisons of preference-weighted questionnaires are limited. By considering several hypothetical health states, we found that utility scores for equivalent states can vary substantially, depending on the measure used. Clinicians and researchers applying preference-weighted HRQL questionnaires should be aware of such differences and exercise caution when interpreting the results. Ć

Pharmacy Education

Background: EuroQol-5 Dimension (EQ-5D) and Short Form-6 dimension (SF-6D) are instruments that have been widely used to assess utility index as an outcome parameter in pharmacoeconomic studies. The choice of an instrument will have an important effect and can influence the decision making of an economic health evaluation. Objectives: The aim of this study was to compare the SF-6D and EQ-5D instruments to assess utility index in cataract patients. Methods: The study was conducted with on 448 cataract patients in a hospital in Yogyakarta. The subjects of the study were outpatient cataract patients over 45 years of age. The patient's health-related quality of life (HRQoL) was assessed using the SF-6D, EQ-5D, and visual function questionnaire instruments. The construct validity was tested including known group validity using the independent sample t test and ANOVA, convergent validity with the Spearman correlation, ceiling effect, and bland and Altmand plots. Results: A ...

Quality of Life Research

Purpose The validity and responsiveness of the EQ-5D-3L in visual conditions has been questioned, inspiring development of a vision ‘bolt-on’ domain (EQ-5D-3L + VIS). Developments in preference-based measures (PBM) also includes the EQ-5D-5L and the ICECAP-O capability wellbeing measure. This study aimed to examine the construct validity and responsiveness of the EQ-5D-3L, EQ-5D-5L, EQ-5D-3L + VIS and ICECAP-O in cataract surgery patients for the first time, to inform choice of PBM for economic evaluation in this population. Methods The analyses used data from the UK Predict-CAT cataract surgery cohort study. PBMs and the Cat-PROM5 [a validated measure of cataract quality of life (QOL)] were completed before surgery and 4–8 weeks after. Construct validity was assessed using correlations and known-group differences evaluated using regression. Responsiveness was evaluated using effect sizes and analysis of variance to compare change scores between groups, defined by patient-reported a...

Medical Care, 2000

Utilities are numeric measurements that reflect an individual's beliefs about the desirableness of a health condition, willingness to take risks to gain health benefits, and preferences for time. This report discusses the approaches to assess and compare the validity of methods used to assign utilities for cost-utility analysis. Threats to validity include construct underrepresentation and construct-irrelevant variance. Construct underrepresentation occurs when a stimulus presented to a judge fails to fully represent the depth and complexity of information required in actual judgments. Construct-irrelevant variation occurs when factors irrelevant to preferences influence measurements of utilities. Among several factors that cause construct-irrelevant variation are cognitive abilities, numeracy skills, emotions and prejudices, and the elicitation procedure. Commonly used elicitation methods (visualanalog scales, time tradeoff, and standard gamble) capture different facets of utilities (desirableness of states, time preferences, and risk attitude) to different degrees. The validity of an elicitation protocol depends (1) on the de-gree to which its scaling method captures the relevant facets of utility and (2) on the degree to which measurements are influenced by construct-irrelevant variation. Discrete-state health index models provide an alternative to direct elicitation of utilities and work by attaching fixed preference weights to observable health states. The creation of discrete-state models with current technologies requires the adoption of strong assumptions about the scaling properties of utilities. Future research must refine methods of eliciting utilities and identify sources of construct-irrelevant variability that reduce the validity of utility assessments. Because of the impact of variation in techniques on measurements, we do not recommend the combination of utilities elicited with different protocols in cost-utility analysis and do not recommend the display of cost-utility ratios from different studies in comparison or "league" tables.

Health and Quality of Life Outcomes, 2007

Background: Diabetes has a high burden of illness both in life years lost and in disability through related co-morbidities. Accurate assessment of the non-mortality burden requires appropriate health-related quality of life and summary utility measures of which there are several contenders. The study aimed to measure the impact of diabetes on various health-related quality of life domains, and compare several summary utility measures.

JAMA ophthalmology, 2014

Understanding how individuals value health states is central to patient-centered care and to health policy decision making. Generic preference-based measures of health may not effectively capture the impact of ocular diseases. Recently, 6 items from the National Eye Institute Visual Function Questionnaire-25 were used to develop the Visual Function Questionnaire-Utility Index health state classification, which defines visual function health states. To describe elicitation of preferences for health states generated from the Visual Function Questionnaire-Utility Index health state classification and development of an algorithm to estimate health preference scores for any health state. Nonintervention, cross-sectional study of the general community in 4 countries (Australia, Canada, United Kingdom, and United States). A total of 607 adult participants were recruited from local newspaper advertisements. In the United Kingdom, an existing database of participants from previous studies wa...