Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-04T07:23:02.637Z Has data issue: false hasContentIssue false

An Introduction to Utility Measurement in Health Care

Published online by Cambridge University Press:  02 January 2015

Beryl M. Ferguson*
Affiliation:
British Columbia Transplant Society, Vancouver British Columbia, Canada
Paul A. Keown
Affiliation:
British Columbia Transplant Society, Vancouver British Columbia, Canada Departments of Medicine and Pathology, Vancouver Hospital and Health Sciences Centre and the University of British Columbia, Vancouver British Columbia, Canada
*
Health Sciences Unit, British Columbia Transplant Society, East Tower, 4th Fl., 555 W 12th Ave., Vancouver, BC, Canada V5Z 3X7

Abstract

Key decisions regarding the introduction and optimal use of health technologies often are made on an ad hoc basis. Quantitative information on effectiveness, if incorporated into the decision-making process, would establish a reasoned and defensible basis for the introduction and optimal use of therapeutic technologies. Utility measures provide a single summary score of effectiveness which, when combined with cost information, permits the calculation of cost-utility ratios for alternative technologies. A number of techniques have been developed to elicit utilities, including standard gamble, time trade-off, rating scales, the Quality of Well-Being Scale, and the Health Utility Index. No single method has been accepted yet as the gold standard. Selection therefore must be guided by the specific objectives of the assessment.

Type
Statistics for Hospital Epidemiology
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. McDowell, I, Newell, C. Measuring Health: A Guide to Rating Scales and Questionnaires. New York, NY: Oxford University Press; 1987.Google Scholar
2. Guyatt, G, Zanten, SV, Feeny, D, Patrick, D. Measuring quality of life in clinical trials: a taxonomy and review. Can Med Assoc J 1989;140:14411448.Google Scholar
3. Canadian, ESG. Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis. Brit Med J 1990;300:573578.Google Scholar
4. Detsky, AS. Guidelines for economic analysis of pharmaceutical products. PhamaEcon 1993;3:354361.Google Scholar
5. Drummond, M, Torrance, G, Mason, J. Cost-effectiveness league tables: more harm than good? Soc Sci Med 1993;37:3340.Google Scholar
6. Sheps, S, Birnbaum, D. Choices: A brief review of economic analysis. Infect Control Hosp Epidemiol 1993;14:337341.Google Scholar
7. Torrance, GW. Utility approach to measuring health-related quality of life. J Chron Dis 1987;40:593600.Google Scholar
8. Mulley, AG. Assessing patients' utilities. Med Cure 1989;27:S269S281.Google Scholar
9. Sox, HC, Blatt, MA, Higgins, MC, Marton, KI. Medical Decision Making. Toronto: Butterworth-Heinemann; 1988.Google Scholar
10. Torrance, GW, Boyle, MH, Horwook, SP. Application of multi-attribute utility theory to measure social preferences for health states. Ops Res 1982;30:10431069.Google Scholar
11. Froberg, DG. Methodology for measuring health-state preferences-l: Measurement Strategies. J Clin Epidemiol 1989;42:345354.Google Scholar
12. Torrance, GW, Thomas, WH, Sackett, DL. A utility maximization. model for evaluation of health care programs. Health Serv Res 1972:118131.Google Scholar
13. Torrance, GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986;5:130.Google Scholar
14. Torrance, GW. Feeny, D. Utilities and quality-adjusted life years. In J Technol Assess Health Care 1989;5:559575.Google Scholar
15. Hornberger, JC, Redelmeier, DA, Petersen, J. Variability among methods to assess patients' well-being and consequent effect on a cost-effectiveness analysis. J Clin Epidemiol 1992;45:505512.CrossRefGoogle ScholarPubMed
16. Tsevat, J, Dawson, NV, Matchar, DB. Assessing quality of life and preferences in the seriously ill using utility theory. J Clin Epidemiol 1990;43 (suppl):73S77S.CrossRefGoogle ScholarPubMed
17. EuroQOL, G. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199208.Google Scholar
18. Rosser, R, Sintonen, H. The EuroQol quality of life project. In: Walker, SR, Rosser, RM, eds. Quality of Life Assessment: Key Issues in the 1990s. London, England: Kluwer Academic Publishers; 1993:197199.Google Scholar
19. Churchill, DN, Torrance, GW, Taylor, DW, et al. Measurement of quality of life in end-stage renal disease: the time tradeoff approach. Clin Invest Med 1987;10:1420.Google Scholar
20. Bombardier, C, et al. Comparison of three preference measurement methodologies in the evaluation of a functional status index. In: Deber, RB, Thompson, GG, eds. Choices in Health Cure. Toronto, Ontario, Canada: University of Toronto; 1982.Google Scholar
21. Read, JL, Quinn, RJ, Berwick, DM, Fineberg, HV, Weinstein, MC. Preferences for health outcomes: comparison of assessment methods. Med Decis Making 1984;4:315329.Google Scholar
22. Llewellyn-Thomas, H, Sutherland, HJ, Tibshirani, R, Ciampi, A, Till, JE, Boyd, NF. Describing health states. Methodological issues in obtaining values for health states. Med Care 1984;22:543552.CrossRefGoogle ScholarPubMed
23. Richardson, J. Cost utility analyses in health care: present status and future issues. 1989. Working paper No. 8, Monash University, Public Section Management Institute, Victoria, Australia; 1989.Google Scholar
24. Kaplan, RM, Bush, JW, Berry, CC. Health status: types of validity and the index of well-being. Health Serv Res 1976;11:478507.Google Scholar
25. Kaplan, RM, Anderson, JP, Ganiats, TG. The Quality of Well-being Scale: rationale for a single quality of life index. In: Walker, SR, Rosser, RM, eds. Quality of Life Assessment: Key Issues in the 1990s. London, England: Kluwer Academic Publishers; 1993:6594.Google Scholar
26. Boyle, M, Torrance, G, Sinclair, J, Horwood, S. Economic evaluation of neonatal intensive care of very-low-birthweight infants. N Engl J Med 1983;308:13301337.Google Scholar
27. Donaldson, C. Willingness to pay for publicly-provided goods: a possible measure of benefit? J Health Econ 1990;9:103118.Google Scholar
28. Gafni, A. Willingness to pay as a measure of benefits. Relevant questions in the context of public decision making about health care programs. Med Care 1991;29:12461252.Google Scholar
29. Banta, HD, Luce, BR. Financial costs and their evaluation. In: Health Care Technology and Its Assessment: An International Perspective. New York, NY: Oxford University Press; 1993:93113.Google Scholar
30. Nord, E. Methods for quality adjustment of life years. Soc Sci Med 1992;34:559569.Google Scholar
31. Weinstein, MC. Challenges for cost-effectiveness research. Med Decis Making 1986;6:195198.CrossRefGoogle ScholarPubMed
32. Tsevat, J, Goldman, L, Lamas, G, et al. Functional status versus utilities in survivors of myocardial infarction. Med Care 1991;29:11531159.Google Scholar
33. Revicki, D. Relationship between health utility and psychometric health status measures. Med Care 1992;30:MS274MS282.Google Scholar
34. Llewellyn-Thomas, HA, Thiel, EC, McGreal, MJ. Cancer patients' evaluations of their current health states. Med Decis Making 1992;12:115122.Google Scholar
35. Groome, PA, Hutchinson, TA, Tousignant, P. Content of a decision analysis for treatment choice in end-stage renal disease. Med Decis Making 1994;14:9197.CrossRefGoogle ScholarPubMed
36. Molzahn, AE. Perceptions of the quality of life of individuals with end stage renal disease. Proceedings of the Annual Meeting and Conference of the Western Region Canadian Association of University Schools of Nursing. Victoria: University of Victoria School of Nursing;1989:2125.Google Scholar
37. Boyd, NF, Sutherland, HJ, Heasman, KZ, Tritchler, DL, Cummings, BJ. Whose utilities for decision analysis. Med Decis Making 1990;10:5866.Google Scholar
38. Sackett, DL, Torrance, GW. The utility of different health states as perceived by the general public. J Chron Dis 1978;31:697704.Google Scholar
39. Christensen-Szalanski, JJ. Discount functions and the measurement of patients' values: women's decisions during childbirth. Med Decis Making 1984;4:4758.Google Scholar
40. O'Connor, AM, Boyd, N, Ward, P. Eliciting preferences for alternative drug therapies in oncology: influence of treatment outcome description, elicitation technique and treatment experience on preferences. J Chron Dis 1987;40:811818.Google Scholar
41. Llewellyn-Thomas, HA, Sutherland, HJ, Thiel, EC. Do patients' evaluations of a future health state change when they actually enter that state? Med Decis Making 1991;11:323. Abstract.Google Scholar
42. Drummond, MF, Stoddart, GL, Torrance, GW. Methods for the Economic Evaluation of Health Care Programmes. Toronto, Ontario, Canada: Oxford University Press; 1987.Google Scholar
43. Hadom, DC. The role of public values in setting health care priorities. Soc Sci Med 1991a;32:773781.Google Scholar
44. Tversky, A, Kahneman, D. The framing of decisions and the psvcholoev of choice. Science 1981;211:453458.Google Scholar
45. McNeil, BJ, Pauker, SG, Sox, HC, et al. On the elicitation of preferences for alternative therapies. N Engl J Med 1982;306:12591262.Google Scholar
46. Torrance, GW. Social preferences for health states: An empirical evaluation of three measurement techniques. Soc-Econ Planning SC 1976;10:129136.Google Scholar
47. Williams, A. The importance of quality of life in policy decision. In: Walker, SR, ed. Quality of Life Assessment: Key Issues in the 1990s. Boston, MA: Kluwer Academic Publishers;1993:427439.Google Scholar
48. CCOHTA Guidelines for the economic evaluation of pharmaceuticals: Canada. 1st ed. Canadian Coordinating Office of Health Technology Assessment, Ottawa, Ontario;1994.Google Scholar
49. Mehrez, A, Gafni, A. The healthy-years equivalents. How to measure them using the standard gamble approach. Med Dec Making 1991;11:140146.Google Scholar
50. Mehrez, A, Gafni, A. Quality-adjusted life years, utility theory, and healthy-years equivalents. Med Decis Making 1989;9:142149.Google Scholar
51. Fryback, DG. QALYs, HYEs, and the loss of innocence. Med Decis Making 1993;13:271272.Google Scholar
52. Detsky, AS, Naglie, G. A clinician's guide to cost-effectiveness analysis. Ann Intern Med 1990;113:147154.Google Scholar
53. Drummond, ME Resource allocation decisions in health care: a role for quality of life assessments. J Chron Dis 1987;40:605616.Google Scholar
54. Churchill, DN, Morgan, J, Torrance, GW. Quality of life in end-stage renal disease. Peritoneul Dialysis Bulletin 1984;4:2023.CrossRefGoogle Scholar
55. Froberg, DG, Kane, RL. Methodology for measuring health-state preferences-II: scaling methods. J Clin Epidemiol 1989;42:459471.Google Scholar
56. Hutchinson, TA, Tousignant, P, Groome, PA. Measuring patients' values for the consequences of end-stage renal disease treatments. Final Scientific Report No. 901421. Montreal: Fonds du Recherches en Sante du Quebec; 1992.Google Scholar
57. Nord, E. The use of EuroQol values in QALY calculations. Lund, Sweden: Institute for Health Economics;1991:8797.Google Scholar
58. Laupacis, A, Feeny, D, Detsky, AS, Tugwell, P. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J 1992;146:473481.Google Scholar
59. Ellwood, PM. A technology of patient experience. N Engl J Med 1988;318:15491556.Google Scholar
60. Laupacis, A, Bourne, R, Rorabeck, C, et al. The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg 1993;75A:16191626.Google Scholar