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PharmacoEconomics

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01-02-2000 | Review Article

Valuing Health-Related Quality of Life

A Review of Health State Valuation Techniques

Authors: Mr Colin Green, John Brazier, Mark Deverill

Published in: PharmacoEconomics | Issue 2/2000

Abstract

Given the growing need to value health-related quality of life, a review of the literature relating to health state valuation techniques was undertaken to appraise the current theoretical and empirical evidence available to inform on the techniques, to identify consensus, identify disagreement and identify important areas for future research. A systematic search of the literature was conducted, covering standard gamble (SG), time trade-off (TTO), visual analogue scale (VAS), magnitude estimation (ME) and person trade-off (PTO) techniques. The basic concepts of practicality, reliability, theoretical validity and empirical validity formed the criteria for reviewing the performance of valuation techniques.

In terms of practicality and reliability, we found little evidence relating to ME and PTO. SG, TTO and VAS have been shown to be practical on a range of populations. There is little difference between the reliability of SG, TTO and VAS, and present evidence does not offer a basis to differentiate between them.

When considering the theoretical basis of techniques, we conclude that choice-based methods (i.e. SG, TTO and PTO) are best placed to reflect the strength of preference for health, with the choice between these techniques depending on the study characteristics and the perspective employed. Empirical evidence relating to the theoretical perspective of the techniques has shown that there are problems with all techniques in terms of descriptive validity.

Note that in this review, we have not concerned ourselves in any detail with the presentation of MAUS or the description of health states. We have undertaken a detailed review of MAUS which can be found in Brazier et al.[7]

Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986; 5: 1–30PubMedCrossRef

Froberg DG, Kane RL. Methodology for measuring health-state preferences. II: scaling methods. J Clin Epidemiol 1989; 42: 459–71PubMedCrossRef

Richardson J. Cost utility analysis: what should be measured? Soc Sci Med 1994; 39: 7–21PubMedCrossRef

Dolan P, Gudex C, Kind P, et al. Valuing health states: a comparison of methods. J Health Econ 1996; 15: 209–31PubMedCrossRef

Froberg DG, Kane RL. Methodology for measuring health-state preferences. III: population and context effects. J Clin Epidemiol 1989; 42: 585–92PubMedCrossRef

Rabin M. Psychology and economics. J Econ Lit 1998; XXXVI: 11–46

Brazier JE, Deverill M, Green C, et al. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999; 3 (9)

Von Neumann J, Morganstern O. Theory of games and economic behaviour. Princeton (NJ): Princeton University Press, 1944

Torrance GW, Thomas WH, Sackett DL. Autility maximization model for evaluation of health care programs. Health Serv Res 1972; 7: 118–33PubMed

10.

Nord E. The person-trade-off approach to valuing health care programs. Med Decis Making 1995; 15: 201–8PubMedCrossRef

11.

Brazier JE, Deverill M. A checklist for judging preference-based measures of health related quality of life: learning from psychometrics. Health Econ 1998; 8: 41–51CrossRef

12.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; I (8476): 307–10CrossRef

13.

Pinto Prades JL. Is the person trade-off a valid method for allocating health care resources? Health Econ 1997; 6: 71–81PubMedCrossRef

14.

Ubel PA, Loewenstein G, Scanlon D, et al. Individual utilities are inconsistent with rationing choices: a partial explanation of why Oregon’s cost-effectiveness list failed. Med Decis Making 1996; 16: 108–16PubMedCrossRef

15.

Dolan P, Gudex C, Kind P, et al. The time trade-off method: results from a general population study. Health Econ 1996; 5: 141–54PubMedCrossRef

16.

Rabin R, Rosser RM, Butler C. Impact of diagnosis on utilities assigned to states of illness. J R Soc Med 1993; 86: 444–8PubMed

17.

Patrick DL, Starks HE, Cain KC, et al. Measuring preferences for health states worse than death. Med Decis Making 1994; 14: 9–18PubMedCrossRef

18.

Morss SE, Lenert LA, Faustman WO. The side effects of antipsychotic drugs and patients’ quality of life: patient education and preference assessment with computers and multimedia. Proc Annu Symp Comput Appl Med Care 1993: 17–21

19.

Ramsey SD, Patrick DL, Lewis S, The University of Washington Medical Center Lung Transplant Study Group, et al. Improvement in quality of life after lung transplantation: a preliminary study. J Heart Lung Transplant 1995; 14: 870–7PubMed

20.

Lenert LA, Morss S, Goldstein MK, et al. Measurement of the validity of utility elicitations performed by computerized interview. Med Care 1997; 35: 915–20PubMedCrossRef

21.

Ashby J, O’Hanlon M, Buxton MJ. The time trade-off technique: how do the valuations of breast cancer patients compare to those of other groups? Qual Life Res 1994; 3: 257–65PubMedCrossRef

22.

Detsky AS, McLaughlin JR, Abrams HB, et al. Quality of life of patients on long-term total parenteral nutrition at home. J Gen Intern Med 1986; 1: 26–33PubMedCrossRef

23.

Glasziou PP, Bromwich S, Simes RJ, for the AUS-TASK Group. Quality of life six months after myocardial infarction treated with thrombolytic therapy. Med J Aust 1994; 161: 532–6PubMed

24.

Johnson ES, Sullivan SD, Mozaffari E, et al. A utility assessment of oral and intravenous ganciclovir for the maintenance treatment of AIDS-related cytomegalovirus retinitis. Pharmacoeconomics 1996; 10: 623–9PubMedCrossRef

25.

Fryback DG, Dasbach EJ, Klein R, et al. The Beaver Dam Health Outcomes Study: initial catalog of health-state quality factors. Med Decis Making 1993; 13: 89–102PubMedCrossRef

26.

Kreibich DN, Vaz M, Bourne RB, et al. What is the best way of assessing outcome after total knee replacement? Clin Orthop 1996; 221–5

27.

Krumins PE, Fihn SD, Kent DL. Symptom severity and patients’ values in the decision to perform a transurethral resection of the prostate. Med Decis Making 1988; 8: 1–8PubMedCrossRef

28.

Torrance GW. Social preferences for health states: an empirical evaluation of three measurement techniques. Soc Econ Plan Sci 1976; 10: 129–36CrossRef

29.

Torrance GW. Utility approach to measuring health-related quality of life. J Chron Dis 1987: 40: 593–603PubMedCrossRef

30.

Kaplan RM, Feeny D, Revicki DA. Methods for assessing relative importance in preference based outcome measures. Qual Life Res 1993; 2: 467–75PubMedCrossRef

31.

Busschbach JJ, Horikx PE, van den Bosch JM, et al. Measuring the quality of life before and after bilateral lung transplantation in patients with cystic fibrosis. Chest 1994; 105: 911–7PubMedCrossRef

32.

Bakker C, Rutten M, van Doorslaer E, et al. Feasibility of utility assessment by rating scale and standard gamble in patients with ankylosing spondylitis or fibromyalgia. J Rheumatol 1994; 21: 269–74PubMed

33.

Silvertssen E, Field NB, Abdelnoor M. Quality of life after open heart surgery. Vasc Surg 1994; 28: 581–8CrossRef

34.

Gudex C, Dolan P, Kind P, et al. Health state valuations from the general public using the visual analogue scale. Qual Life Res 1996; 5: 521–31PubMedCrossRef

35.

Reed WW, Herbers Jr JE, Noel L. Cholesterol-lowering therapy: what patients expect in return. J Gen Intern Med 1993; 8: 591–6PubMedCrossRef

36.

van der Donk J, Levendag PC, Kuijpers AJ, et al. Patient participation in clinical decision-making for treatment of T3 laryngeal cancer: a comparison of state and process utilities. J Clin Oncol 1995; 13: 2369–78PubMed

37.

Revicki DA. Relationship between health utility and psychometric health status measures. Med Care 1992; 30: MS274–82CrossRef

38.

Gage BF, Cardinalli AB, Owens DK. The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life. Arch Intern Med 1996; 156: 1829–36PubMedCrossRef

39.

Llewellyn Thomas H, Sutherland HJ, et al. The measurement of patients’ values in medicine. Med Decis Making 1982; 2: 449–62PubMedCrossRef

40.

Stiggelbout AM, Kiebert GM, Kievit J, et al. Utility assessment in cancer patients: adjustment of time tradeoff scores for the utility of life years and comparison with standard gamble scores. Med Decis Making 1994; 14: 82–90PubMedCrossRef

41.

Essink Bot ML, Bonsel GJ, van der Maas PJ. Valuation of health states by the general public: feasibility of a standardized measurement procedure. Soc Sci Med 1990; 31: 1201–6PubMedCrossRef

42.

Cairns J, Shackley P, Hundley V. Decision making with respect to diagnostic testing: a method of valuing the benefits of antenatal screening. Med Decis Making 1996; 16: 161–8PubMedCrossRef

43.

Loomes G, McKenzie L. The use of QALYs in health care decision making. Soc Sci Med 1989; 28: 299–308PubMedCrossRef

44.

Scott A. Giving things up to have more of others: the implications of limited substitutability for eliciting preferences in health and health care. UK Health Economists Study Group Meeting: 1998 Jan 5–7; Sheffield

45.

Handler RM, Hynes LM, Nease Jr RF. Effect of locus of control and consideration of future consequences on time tradeoff utilities for current health. Qual Life Res 1997; 6: 54–60PubMedCrossRef

46.

Nease Jr RF, Kneeland T, O’Connor GT, Ischemic Heart Disease Patient Outcomes Research Team, et al. Variation in patient utilities for outcomes of the management of chronic stable angina: implications for clinical practice guidelines. [published erratum appears in JAMA 1995; 274 (8): 612]. JAMA 1995; 273: 1185–90PubMedCrossRef

47.

Nease Jr RF, Tsai R, Hynes LM, et al. Automated utility assessment of global health. Qual Life Res 1996; 5: 175–82PubMedCrossRef

48.

Krahn MD, Mahoney JE, Eckman MH, et al. Screening for prostate cancer: a decision analytic view. JAMA 1994; 272: 773–80PubMedCrossRef

49.

Clarke AE, Goldstein MK, Michelson D, et al. The effect of assessment method and respondent population on utilities elicited for Gaucher disease. Qual Life Res 1997; 6: 169–84PubMedCrossRef

50.

Rosser R, Kind P. A scale of valuations of states of illness: is there a social consensus? Intern J Epidemiol 1978; 7: 347–58CrossRef

51.

Nord E. The trade-off between severity of illness and treatment effect in cost-value analysis of health care. Health Policy 1993; 24: 227–38PubMedCrossRef

52.

O’Brien B, Viramontes JL. Willingness to pay: a valid and reliable measure of health state preference? Med Decis Making 1994; 14: 289–97PubMedCrossRef

53.

O’Connor AM, Boyd NF, Warde P, et al. 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: 811–8PubMedCrossRef

54.

Gabriel SE, Campion ME, O’Fallon WM. Acost-utility analysis of misoprostol prophylaxis for rheumatoid arthritis patients receiving nonsteroidal anti-inflammatory drugs. Arthritis Rheum 1994; 37: 333–41PubMedCrossRef

55.

Molzahn AE, Northcott HC, Hayduk L. Quality of life of patients with end stage renal disease: a structural equation model. Qual Life Res 1996; 5: 426–32PubMedCrossRef

56.

Johannesson M, Jonsson B, Karlson G. Outcome measurement in economic evaluation. Health Econ 1996; 5: 279–96PubMedCrossRef

57.

Nord E. The validity of a visual analogue scale in determining social utility weights for health states. Int J Health Plann Manage 1991; 6: 234–42PubMedCrossRef

58.

Dyer JS, Sarin RK. Relative risk aversion. Manage Sci 1982; 28: 875–86CrossRef

59.

Torrance GW, Feeny DH, Furlong WJ, et al. Multi attribute utility function for a comprehensive health status classification system: Health Utilities Index Mark 2. Med Care 1996; 34: 702–22PubMedCrossRef

60.

Stevens SS. Issues in psychophysical measurement. Psychol Rev 1971; 78: 426–50CrossRef

61.

Patrick DL, Bush JW, Chen MM. Methods for measuring levels of well-being for a health status index. Health Serv Res 1973; 8: 228–45PubMed

62.

Kaplan RM, Bush JW, Berry CC. Health status index: category rating versus magnitude estimation for measuring levels of well-being. Med Care 1979; 17: 501–25PubMedCrossRef

63.

Mehrez A, Gafni A. Evaluating health related quality of life: an indifference curve interpretation for the time trade-off technique. Soc Sci Med 1990; 31: 1281–3PubMedCrossRef

64.

Buckingham JK, Birdsall J, Douglas JG. Comparing three versions of the time tradeoff: time for a change? Med Decis Making 1996; 16: 335–47PubMedCrossRef

65.

Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chron Dis 1981; 31: 697–704CrossRef

66.

Sutherland HJ, Llewellyn Thomas H, et al. Attitudes towards quality of survival: the concept of maximum endurable time. Med Decis Making 1982; 2: 299–309PubMedCrossRef

67.

Dolan P, Gudex C. Time preference, duration and health state valuations. Health Econ 1995; 4: 289–99PubMedCrossRef

68.

Mehrez A, Gafni A. The healthy-years equivalents: how to measure them using the standard gamble approach. Med Decis Making 1991; 11: 140–6PubMedCrossRef

69.

Gafni A. The standard gamble method: what is being measured and how it is interpreted. Health Serv Res 1994; 29: 207–24PubMed

70.

Torrance GW, Feeny D. Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989; 5: 559–75PubMedCrossRef

71.

Loomes G, Sugden R. Regret theory: an alternative theory of rational choice under uncertainty. Econ J 1982; 92: 805–24CrossRef

72.

Kahneman D, Tversky A. Prospect theory: an analysis of decision under risk. Econometrica 1979; 47: 263–91CrossRef

73.

Bleichrodt H, Johannesson M. An experimental test of a theoretical foundation for rating-scale valuations. Med Decis Making 1997; 17: 208–16PubMedCrossRef

74.

Loomes G, Jones LeeM, Robinson A. What do visual analogue scales actually mean? UK Health Economists Study Group Meeting: 1994 Jul 6–8; Newcastle

75.

Kuppermann M, Shiboski S, Feeny D, et al. Can preference scores for discrete states be used to derive preference scores for an entire path of events? An application to prenatal diagnosis. Med Decis Making 1997; 17: 42–55PubMedCrossRef

76.

Cher DJ, Miyamoto J, Lenert LA. Incorporating risk attitude into Markov-process decision models: importance for individual decision making. Med Decis Making 1997; 17: 340–50PubMedCrossRef

77.

Kahneman D, Tversky, A. The psychology of preferences. Sci Am 1982; 246: 160–73CrossRef

78.

Stiggelbout AM, Kiebert GM, Kievit J, et al. The ’utility’of the time trade-off method in cancer patients: feasibility and proportional trade-off. J Clin Epidemiol 1995; 48: 1207–14PubMedCrossRef

79.

Read JL, Quinn RJ, Berwick DM, et al. Preferences for health outcomes: comparison of assessment methods. Med Decis Making 1984; 4: 315–29PubMedCrossRef

80.

Hershey JC, Kunrather HG, Schoemaker PJH. Sources of bias in assessment procedures for utility functions. Manage Sci 1981; 28: 936–54CrossRef

81.

Schoemaker PJH. The expected utility model: its variants, purposes, evidence and limitations. J Econ Lit 1982; 20 (2): 529–63

82.

Gafni A, Birch S. Preferences for outcomes in economic evaluation: an economic approach to addressing economic problems. Soc Sci Med 1995; 40: 767–76PubMedCrossRef

83.

Rutten van Molken MP, Bakker CH, van Doorslaer EK, et al. Methodological issues of patient utility measurement: experience from two clinical trials. Med Care 1995; 33: 922–37CrossRef

84.

Zug KA, Littenberg B, Baughman RD, et al. Assessing the preferences of patients with psoriasis: a quantitative, utility approach. Arch Dermatol 1995; 131: 561–8PubMedCrossRef

85.

Bakker C, Rutten M, van Santen Hoeufft M, et al. Patient utilities in fibromyalgia and the association with other outcome measures. J Rheumatol 1995; 22: 1536–43PubMed

86.

Robinson A, Dolan P, Williams A. Valuing health states using VAS and TTO: what lies behind the numbers? Soc Sci Med 1997; 45: 1289–97PubMedCrossRef

87.

Gudex C, Kind P, van-Dalen H, et al. Comparing scaling methods for health state valuations: Rosser revisited. York: Centre for Health Economics, University of York, 1993. Discussion paper no.: 107

88.

Bosch JL, Hunink MG. The relationship between descriptive and valuational quality-of-life measures in patients with intermittent claudication. Med Decis Making 1996; 16: 217–25PubMedCrossRef

89.

Reed WW, Herbers Jr JE, Noel GL. Cholesterol-lowering therapy: what patients expect in return. J Gen Intern Med 1993; 8: 591–6PubMedCrossRef

90.

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: 505–12PubMedCrossRef

91.

Churchill DN, Torrance GW, Taylor DW, et al. Measurement of quality of life in end-stage renal disease: the time trade-off approach. Clin Invest Med 1987; 10: 14–20PubMed

Title: Valuing Health-Related Quality of Life
A Review of Health State Valuation Techniques
Authors: Mr Colin Green
John Brazier
Mark Deverill
Publication date: 01-02-2000
Publisher: Springer International Publishing
Published in: PharmacoEconomics / Issue 2/2000
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200017020-00004

At a glance: The STEP trials

Springer Medicine

Valuing Health-Related Quality of Life

A Review of Health State Valuation Techniques

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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