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Comparing Multi-Attribute Utility Measures: EQ-5D, HUI, and SF-6D Workshop for 6 th World Congress of International Health Economics Association, Lund, Sweden, July 6, 2007

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Comparing multi attribute utility measures eq 5d hui and sf 6d l.jpg
Comparing Multi-Attribute Utility Measures: EQ-5D, HUI, and SF-6D

Workshop for 6th World Congress of International Health Economics Association, Lund, Sweden,

July 6, 2007

  • David Feeny, Kaiser Permanente Northwest Center for Health Research, Institute of Health Economics, University of Alberta, and Health Utilities Inc.

  • John Horsman, McMaster University, and Health Utilities Inc.

  • Assisted by: Keiko Asakawa, Institute of Health Economics and University of Alberta

    and Morag Horsman, McMaster University


Comparing multi attribute utility measures eq 5d hui and sf 6d2 l.jpg
Comparing Multi-Attribute Utility Measures: EQ-5D, HUI, and SF-6D

Outline

  • Introduction/Administration of Selected Multi-Attribute Utility Measures

  • Conceptual Foundations

  • Direct Approaches to Obtaining Utility Scores for Health States

  • Multi-Attribute or Indirect Approaches to Obtaining Utility Scores for Health States

  • Evidence on Measurement Properties of Utility Measures: Reliability, Construct Validity, Responsiveness, Floor/Ceiling Effects, Predictive Validity, Interpretability

  • Applications in Cost-Effectiveness/Cost-Utility Analyses

  • Comparisons Among Measures

  • Criteria for Selecting an Appropriate Measure for your Study

  • Results from Demonstration

  • Summary


Hypothetical health state for valuation l.jpg
Hypothetical Health State for Valuation SF-6D

Health State “B”

  • Able to see, hear, and speak normally.

  • Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around independently.

  • Occasionally angry, irritable, anxious, or depressed.

  • Able to learn and remember normally.

  • Eats, bathes, dresses, or uses the toilet independently with difficulty.

  • Free of pain and discomfort.


Slide4 l.jpg

V SF-6Disual Analogue Scale

“Feeling Thermometer”

© Health Utilities Inc. (HUInc.) 2006


Slide5 l.jpg

TIME TRADE-OFF BOARD SF-6D

Your

age

now

Your

age

now

Life “A”

10

10

20

20

30

30

40

40

YEARS OF LIFE

Life “B”

YEARS OF LIFE

A standard, blank, Time Trade-off Board on which you select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide6 l.jpg

TTO Scoring template - use 1 SF-6Dst “Stop sign”

TIME TRADE-OFF

PREFER “A”

EQUAL

PREFER “B”

T1

T2

T3

T4

T5

© Health Utilities Inc. (HUInc.) 2006


Slide7 l.jpg

TIME TRADE-OFF BOARD SF-6D

Your

age

now

Your

age

now

Life “A”

10

10

20

20

30

30

40

40

PERFECT HEALTH

Able to see, hear, and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

YEARS OF LIFE

Life “B”

YEARS OF LIFE

T1

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

“Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?”

© Health Utilities Inc. (HUInc.) 2006


Slide8 l.jpg

TIME TRADE-OFF BOARD SF-6D

Your

age

now

Your

age

now

Life “A”

10

10

20

20

30

30

40

40

PERFECT HEALTH

Able to see, hear, and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

YEARS OF LIFE

Life “B”

YEARS OF LIFE

T2

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

“Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?”

© Health Utilities Inc. (HUInc.) 2006


Slide9 l.jpg

TIME TRADE-OFF BOARD SF-6D

Your

age

now

Your

age

now

Life “A”

10

10

20

20

30

30

40

40

PERFECT HEALTH

Able to see, hear, and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

YEARS OF LIFE

Life “B”

YEARS OF LIFE

T3

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

“Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?”

© Health Utilities Inc. (HUInc.) 2006


Slide10 l.jpg

TIME TRADE-OFF BOARD SF-6D

Your

age

now

Your

age

now

Life “A”

10

10

20

20

30

30

40

40

PERFECT HEALTH

Able to see, hear, and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

YEARS OF LIFE

Life “B”

YEARS OF LIFE

T4

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

“Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?”

© Health Utilities Inc. (HUInc.) 2006


Slide11 l.jpg

TIME TRADE-OFF BOARD SF-6D

Your

age

now

Your

age

now

Life “A”

10

10

20

20

30

30

40

40

PERFECT HEALTH

Able to see, hear, and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

YEARS OF LIFE

Life “B”

YEARS OF LIFE

T5

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

“Life ‘A’ Perfect Health” or “Life ‘B’ Health State B” or “Equal?”

© Health Utilities Inc. (HUInc.) 2006


Slide12 l.jpg

Standard Gamble Chance Board SF-6D

Select Life “A” or Life “B” or are they ‘equal?’

© Health Utilities Inc. (HUInc.) 2006


Slide14 l.jpg

CHANCE BOARD SF-6D

S1

Life “A”

100

0

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide15 l.jpg

CHANCE BOARD SF-6D

S2

Life “A”

10

90

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide16 l.jpg

CHANCE BOARD SF-6D

S3

Life “A”

90

10

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide17 l.jpg

CHANCE BOARD SF-6D

S4

Life “A”

20

80

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide18 l.jpg

CHANCE BOARD SF-6D

S5

Life “A”

80

20

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide19 l.jpg

CHANCE BOARD SF-6D

S6

Life “A”

30

70

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide20 l.jpg

CHANCE BOARD SF-6D

S7

Life “A”

70

30

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide21 l.jpg

CHANCE BOARD SF-6D

S8

Life “A”

40

60

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide22 l.jpg

CHANCE BOARD SF-6D

S9

Life “A”

60

40

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Slide23 l.jpg

CHANCE BOARD SF-6D

S10

Life “A”

50

50

% CHANCE

% CHANCE

PERFECT HEALTH

Able to see, hear and speak normally.

Able to walk, bend, lift, jump, and run normally for age.

Generally happy and free from worry.

Able to learn and remember normally.

Able to eat, bathe, dress, and use the toilet normally.

Free of pain and discomfort.

IMMEDIATE DEATH

Life “B”

Health State “B”

Able to see, hear and speak normally.

Requires mechanical equipment (cane, crutches, braces, wheelchair) to walk or get around.

Occasionally angry, irritable, anxious, or depressed.

Able to learn and remember normally.

Eats, bathes, dresses, or uses the toilet independently with difficulty.

Free of pain and discomfort.

100

% CHANCE

Standard Gamble Chance Board Select Life “A” or Life “B” or are they ‘equal’

© Health Utilities Inc. (HUInc.) 2006


Comparing multi attribute utility measures eq 5d hui and sf 6d24 l.jpg
Comparing Multi-Attribute Utility Measures: EQ-5D, HUI, and SF-6D

Outline

Introduction/Administration of Selected Multi-Attribute Utility Measures

Conceptual Foundations

Direct Approaches to Obtaining Utility Scores for Health States

Multi-Attribute or Indirect Approaches to Obtaining Utility Scores for Health States

Evidence on Measurement Properties of Utility Measures: Reliability, Construct Validity, Responsiveness, Floor/Ceiling Effects, Predictive Validity, Interpretability

Applications in Cost-Effectiveness/Cost-Utility Analyses

Comparisons Among Measures

Criteria for Selecting an Appropriate Measure for your Study

Results from Demonstration

Summary


Desirable properties for measures of hrql l.jpg
Desirable Properties SF-6Dfor Measures of HRQL

Acceptability

Burden

Reliability

Validity

Responsiveness

Interpretability

Usefulness


Major uses of utility measures of hrql l.jpg
Major Uses of Utility Measures of HRQL SF-6D

As an Outcome Measure

Input into Economic Evaluations (Cost-Effectiveness, Cost Utility, Cost-Benefit Analyses)

Input into Health Technology Assessments


Useful properties of utility measures of hrql l.jpg
Useful Properties of Utility Measures of HRQL SF-6D

Comprehensive

Conventional Scale:

Dead = 0.00; Perfect Health = 1.00

Interval-Scale Properties

Permit Broad Comparisons

Integrate Treatment Process and Outcome

Integrate over Time

Integrate Mortality and Morbidity

Link Clinical and Population Health Applications


Taxonomy of measures of health related quality of life l.jpg
Taxonomy of Measures of Health-Related Quality of Life SF-6D

I. Specific Instruments

II. Generic Instruments

Health-Profile Measures

Utility (Preference-Based) Measures

Source: Guyatt, Feeny, and Patrick (1993).


Slide29 l.jpg

Definitions and Concepts SF-6D

Three Major Paradigms in HRQL Measurement

Psychometric

Clinimetric

Utility/Preference-Based

Purposes of Measurement

Description - Assess Burden of Morbidity

Assess Place of Individual/Group in the Distribution of Health Status

Discrimination

Prediction

Evaluation: Assess Within-Person Change over Time - Individual Patients, Groups, Clinical Trials

Valuation of Health Status - Conventional Scale (Dead = 0.00; Perfect Health = 1.00)

Assist in Informing Resource Allocation Decisions

Approaches to the Assessment of Health-Related Quality of Life (HRQL)


A definition of hrql l.jpg
A Definition of HRQL SF-6D

“Health-related quality of life is the value assigned to duration of life as modified by the impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy.”

Source: Donald L. Patrick and Pennifer Erickson, Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York: Oxford University Press, 1993, p 22.


Slide31 l.jpg

Axioms of Cardinal Expected Utility Theory SF-6D

  • Rational behavior under risk (uncertainty) consists of:

  • Preferences for outcomes exist and are transitive,

  • e.g. if A > B and B > C, then A > C

  • Preferences for a risky prospect are independent of whether it has one stage or two,

  • e.g. if P1 = (0.5A, 0.5P2) where P2 = (0.5A, 0.5B), and P3 = (0.75A, 0.25B), then P1 ~ P3

  • Preferences are continuous (Standard Gamble), e.g. if A > B > C, then there is some probability p such that the person is indifferent between B for sure and a risky prospect (pA, (1-p)C) [Continuity Axiom]


Basic underlying heuristic framework from economics l.jpg
Basic Underlying Heuristic Framework from Economics SF-6D

Utility = U(C, HS)

where U is the utility function;

C = composite final consumption good;

HS = health status.

Further assume that U/  C > 0;

 U/  HS > 0.

Final “goods” (C, HS) are produced within the household using time and inputs purchased from the market


Implications for the valuation of health status l.jpg
Implications for the Valuation of SF-6DHealth Status

1. Intrinsic Value of Health Status

  Health status is an argument in the utility function; it contributes directly to utility, well being, or life satisfaction.

2. “Indirect” Value of Health Status

  Being healthy reduces time lost due to illness and enhances productivity in market work and household production and thus has “indirect” value.

3.Scope.

Scope of utility measure needs to be specified. Is the measure intended to cover the intrinsic value only or both the intrinsic value and the indirect value?


Direct approaches to obtaining utility scores for health states l.jpg
Direct Approaches to Obtaining Utility Scores for Health States

Rank Ordering of Health States

Category Scaling/Visual Analogue Scale (VAS) - Feeling Thermometer (FT)

Choice-Based Techniques

  Time Tradeoff (TTO)

  Standard Gamble (SG)

Note: CS/VAS/FT and TTO scores technically are value scores; SG scores are utility scores.


Feeling thermometer l.jpg
Feeling StatesThermometer

-- 100 --

-- 95 --

-- 90 --

-- 85 --

-- 80 --

-- 75 --

-- 70 --

-- 65 --

-- 60 --

-- 55 --

-- 50 --

-- 45 --

-- 40 --

-- 35 --

-- 30 --

-- 25 --

-- 20 --

-- 15 --

-- 10 --

-- 5 --

-- 0 --

Most Desirable

Perfect Health

Health State #2

Health State #3

Health State #1

Dead

Least Desirable


Time trade off for a chronic health state preferred to dead l.jpg
Time Trade-Off for a Chronic Health State Preferred to Dead States

Value

Alternative 2

HEALTHY

1.0

Alternative 1

STATE i

hi

0.0

DEAD

Time

t

x

TTO Value Score for State i = x*/t (where x* is the indifference time)

Source: Drummond, O’Brien, Stoddart, and Torrance (1997), p. 155.


Standard gamble for a chronic health state preferred to dead l.jpg
Standard Gamble for a Chronic Health State Preferred to Dead

HEALTHY

Probability p

Alternative 1

DEAD

Probability 1-p

Alternative 2

STATE i

Utility of State i = p* (indifference probability)


Multi attribute or indirect approaches for obtaining utility scores for health states l.jpg
Multi-Attribute or Indirect Approaches for Obtaining Utility Scores for Health States

  • Assess Health Status using Existing Multi-Attribute Health Status Classification System

  • Value Health Status using Existing Multi-Attribute Preference Function, typically based on Community Preferences

  • Selected Prominent Systems:

    Quality of Well Being Scale (QWB)

    EuroQol, EQ-5D

    Health Utilities Index (HUI)

    Short-Form 6D (SF-6D)


Quality of well being sa kaplan and anderson 1996 l.jpg

Number of Attributes Scores for Health States

Mobility

Physical Activity

Social Activity

Symptom/Problem Complex

Number of Health States

4

3 Levels

3 Levels

5 Levels

27 Levels

1,215

QUALITY OF WELL-BEING - SA(Kaplan and Anderson 1996)

Scoring Function: Based on VAS Scores; Linear Additive; Scores: 0.00 to1.00


Euroqol eq 5d essink bot et at 1993 dolan 1997 shaw et al 2005 l.jpg

Number of Attributes Scores for Health States

Mobility

Self-Care

Usual Activities

Pain/Discomfort

Anxiety/Depression

Number of Health States

5

3 Levels

3 Levels

3 Levels

3 Levels

3 Levels

243

EuroQol, EQ-5D(Essink-Bot et at., 1993; Dolan 1997; Shaw et al. 2005)

Scoring Function: Based on TTO; Ad Hoc ModifiedLinear Additive; UK Scores: -0.59 to1.00; US Scores: -0.11 to 1.00


Slide41 l.jpg

Number of Attributes Scores for Health States

Physical Function

Role Limitation

Social Functioning

Pain

Mental Health

Vitality

Number of Health States

6

6 Levels

4 Levels

5 Levels

6 Levels

5 Levels

5 Levels

18,000

The Short Form 6D(Based on SF-36 and SF-12) (Brazier, Roberts, and Deverill 2002; Brazier and Roberts 2004)

Scoring Function: Based on SG; Ad Hoc Modified Linear Additive; Scores: 0.00 = Dead; 0.30 = all-worst 6D state; 1.00 = perfect health. The version based on SF-12 describes 7,500 health states; see Brazier and Roberts 2004.


Hui attributes l.jpg
HUI Scores for Health States ® Attributes

  • HUI2

    1. Sensation (4 levels) 5. Self-Care (4 levels)

    2. Mobility (5 levels) 6. Pain (5 levels)

    3. Emotion (5 levels) 7. Fertility (3 levels) - optional

    4. Cognition (4 levels)

    • Partial structural independence; 24,000 health states

    • -0.03 for all-worst HUI2 state; 0.00 for Dead; 1.00 for Perfect Health

    • Multiplicative multi-attribute utility function based on VAS and SG

  • HUI3

    1. Vision (6 levels) 5. Dexterity (6 levels)

    2. Hearing (6 levels) 6. Emotion (5 levels)

    3. Speech (5 levels) 7. Cognition (6 levels)

    4. Ambulation (6 levels) 8. Pain (5 levels)

    • Full structural independence; 972,000 health states

    • -0.36 for all-worst HUI3 state; 0.00 for Dead; 1.00 for Perfect Health

    • Multiplicative multi-attribute utility function based on VAS and SG

      Sources: Horsman et al. 2003; Furlong et al. 2001.


  • Health utilities index mark 3 system hui3 l.jpg
    Health Utilities Index Mark 3 System (HUI3) Scores for Health States

    Attribute Level Level Description

    EMOTION

    1 Happy and interested in life

    2 Somewhat happy

    3 Somewhat unhappy

    4 Very unhappy

    5 So unhappy that life is not worthwhile.

    Source: Feeny, Torrance, and Furlong (1996).


    Major functional forms for multi attribute utility functions l.jpg
    Major Functional Forms for Multi-Attribute Utility Functions Scores for Health States

    Let uj (xj) = the single attribute utility function for attribute j.

    Additive:

    u(x) = kj uj (xj)

    where  kj = 1

    Multiplicative:

    u (x) = (1/k) [ (1 + k kj uj (xj)) -1]

    where (1 + k) =  (1 + k kj)

    Multilinear:

    u (x) = k1 u1 (x1) + k2 u2 (x2) + ...

    + k12 u1 (x1) u2 (x2) + k13 u1 (x1) u3 (x3) + ...

    K123 u1 (x1) u2 (x2) u3 (x3) + ...

    + ...

    where  All k’s = 1


    Major approaches to the estimation of multi attribute utility functions l.jpg
    Major Approaches to the Estimation of Multi-Attribute Utility Functions

    • Statistical Inference/Regression Models

      EQ-5D, SF-6D

    • Decomposed Approach

      HUI1, HUI2, HUI3


    Eq 5d perfect health l.jpg
    EQ-5D “Perfect Health” Utility Functions

    • I have no problems walking about

    • I have no problems with self care

    • I have no problems with performing my usual activities

    • I have no pain or discomfort

    • I am not anxious or depressed


    Eq 5d all worst state l.jpg
    EQ-5D “All-Worst State” Utility Functions

    • I am confined to bed

    • I am unable to wash or dress myself

    • I am unable to perform my usual activities

    • I have extreme pain or discomfort

    • I am extremely anxious or depressed


    Slide48 l.jpg

    Thought Experiment Utility Functions

    Part A. Imagine that you go from perfect health in the EQ-5D system (1,1,1,1,1) to “I have some problems in walking about”, otherwise healthy (2,1,1,1,1)

    Please Think About the Decrement in Your Health-Related Quality of Life

    Part B. Imagine that you have the health state (1,2,2,2,2): no problems with mobility, but some problems with self-care, usual activities, pain, and anxiety/depression. What score do you attach to this health state?

    Now imagine that you go from (1,2,2,2,2) to the health state (2,2,2,2,2), some problems in all 5 dimensions.

    Please Think About the Decrement in Your Health-Related Quality of Life

    Part C. Please compare the decrement in Part A to the decrement in Part B


    Eq 5d scoring formula uk tto version l.jpg
    EQ-5D Scoring Formula, UK TTO Version Utility Functions

    Source: Drummond, et al. (1997), p 164.


    Eq 5d scoring formula us tto version l.jpg
    EQ-5D Scoring Formula, US TTO Version Utility Functions

    Dimension Coefficient

    Mobility, level 2 -0.146

    Mobility, level 3 -0.558

    Self-care, level 2 -0.175

    Self-care, level 3 -0.471

    Usual Activity, level 2 -0.140

    Usual Activity, level 3 -0.374

    Pain/discomfort, level 2 -0.173

    Pain/discomfort, level 3 -0.537

    Anxiety/depression, level 2 -0.156

    Anxiety/depression, level 3 -0.450

    D1, # dimensions at level 2 or 3, beyond 1st 0.140

    I2-squared -0.011

    I3 0.122

    I3-squared 0.015

    Note: I2-squared = square of # of dimensions at level 2 beyond 1st; I3 = # of dimensions at level 3 beyond 1st.

    Source: Shaw et al. 2005, Appendix 2, p 220.


    Sf 6d scoring formula uk sg version l.jpg
    SF-6D Scoring Formula, UK SG Version Utility Functions

    DimensionCoefficient

    PF2 -0.053

    PF3 -0.011

    PF4 -0.040

    PF5 -0.054

    PF6 -0.111

    RL2 -0.053

    RL3 -0.055

    RL4 -0.050

    SF2 -0.055

    SF3 -0.067

    SF4 -0.070

    SF5 -0.087


    Sf 6d scoring formula uk sg version cont l.jpg
    SF-6D Scoring Formula, UK SG Version, cont. Utility Functions

    DimensionCoefficient

    Pain2 -0.047

    Pain3 -0.025

    Pain4 -0.056

    Pain5 -0.091

    Pain6 -0.167

    MH2 -0.049

    MH3 -0.042

    MH4 -0.109

    MH5 -0.128

    VIT2 -0.086

    VIT3 -0.061

    VIT4 -0.054

    VIT5 -0.091

    Most -0.070

    Note: Most takes a value of one if any dimension is at its most severe level.

    Source: Brazier et al. 2002, Table 6, column (10), p 288.


    Slide53 l.jpg

    Attribute Utility Functions

    Level

    Vision

    u1

    Hearing

    u2

    Speech

    u3

    Ambulation

    u4

    Dexterity

    u5

    Emotion

    u6

    Cognition

    u7

    Pain

    u8

    1

    1.00

    1.00

    1.00

    1.00

    1.00

    1.00

    1.00

    1.00

    2

    0.95

    0.86

    0.82

    0.83

    0.88

    0.91

    0.86

    0.92

    3

    0.73

    0.71

    0.67

    0.67

    0.73

    0.73

    0.92

    0.77

    4

    0.59

    0.48

    0.41

    0.36

    0.45

    0.33

    0.70

    0.48

    5

    0.38

    0.32

    0.00

    0.16

    0.20

    0.00

    0.32

    0.00

    6

    0.00

    0.00

    n/a

    0.00

    0.00

    n/a

    0.00

    n/a

    HUI3 Single-Attribute Utility Functions

    Legend: ux - single-attribute utility function for attribute x;

    n/a - not applicable.

    Note: - the mean single-attribute utility score for Level 3 Cognition is greater than the mean single-attribute utility score for Level 2 Cognition.

    Source: Feeny et al. (2002), Table 4, p. 125


    Slide54 l.jpg

    Attribute Utility Functions

    Level

    Vision

    b1

    Hearing

    b2

    Speech

    b3

    Ambulation

    b4

    Dexterity

    b5

    Emotion

    b6

    Cognition

    b7

    Pain

    b8

    1

    1.00

    1.00

    1.00

    1.00

    1.00

    1.00

    1.00

    1.00

    2

    0.98

    0.95

    0.94

    0.93

    0.95

    0.95

    0.92

    0.96

    3

    0.89

    0.89

    0.89

    0.86

    0.88

    0.85

    0.95

    0.90

    4

    0.84

    0.80

    0.81

    0.73

    0.76

    0.64

    0.83

    0.77

    5

    0.75

    0.74

    0.68

    0.65

    0.65

    0.46

    0.60

    0.55

    6

    0.61

    0.61

    n/a

    0.58

    0.56

    n/a

    0.42

    n/a

    HUI3 Multiplicative Multi-Attribute Utility Function On Dead-Healthy Scale

    Legend: bj – model parameter estimate for level of attribute j; n/a - not applicable.

    Formula (Dead-Perfect Health Scale) u* = 1.371 x (b1 x b2 x b3 x b4 x b5 x b6 x b7 x b8)-0.371

    where u* is the utility of a chronic health state on the utility scale (Dead=0.00, Healthy=1.00)

    Source: Feeny et al. (2002), Table 3, p. 124


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    Summary of Evidence on Test-Retest Reliability of Utility Measures

    VAS: correlations of 0.62 to 0.95

    TTO: correlations of 0.63 to 0.81

    SG: correlations of 0.53 to 0.83

    EQ-5D: correlations of 0.63 to 0.80

    HUI: correlations of 0.71 to 0.80

    QWB: correlations of 0.90 in many studies

    SF-36: correlations of 0.60 to 0.81


    Concept of construct validity l.jpg
    Concept of Construct Validity Measures

    “Construct validity is evaluated through a series of hypotheses and tests of these hypotheses regarding the relationships between an instrument and other measures of similar and dissimilar domains or characteristics.”

    Source: Revicki et al. 2000.

    Also test hypotheses using known-groups approach.


    Summary of evidence on measurement properties of utility measures l.jpg
    Summary of Evidence on Measurement Properties of Utility Measures

    Cross-sectional Construct Validity

    Longitudinal Construct Validity/Responsiveness

    Predictive Validity


    Known groups approach example mean hui2 overall utility scores l.jpg
    Known Groups Approach MeasuresExample: Mean HUI2 Overall Utility Scores

    Note: CDR = Clinical Dementia Rating Scale; ELBW = extremely low birthweight; ALL = acute lymphoblastic leukemia; SF = standard risk; HR = high risk

    Sources: (1) and (8) Saigal et al. 1994; (2) and (3) Barr et al. 1993; (4) Feeny et al. 1993; (5) Barr et al. 1999; (6) Whitton et al. 1997; (7) Glaser et al. 1999; (9) Mathias et al. 1997; (10) Neumann et al. 1999; (11-14) Barr et al. 2002.


    Known groups approach multiple sclerosis hui2 overall scores l.jpg
    Known Groups Approach: Multiple Sclerosis/HUI2 Overall Scores

    Mean Overall HUI2 Score by EDSS Category

    EDSS 1-2 EDSS 3-4 EDSS 5-6

    0.84 0.71 0.60

    Mean HUI2 Score during Relapse: 0.68

    Mean HUI2 Score during Remission: 0.75

    Note: EDSS = Expanded Disability Status Scale; ordinal scale in which 0 = normal, 10 = death from MS

    Source: Grima et al. 2000.


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    Known Groups Approach: Community Health Survey Scores

    Source: Macran et al. 2003.


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    Construct Validity and Responsiveness in Recovery After Stroke

    Overall Scores

    Baseline 6 Months Change

    Measure

    EQ-5D(UK) 0.31 0.62 0.31

    EQ-5D(us) 0.47 0.71 0.24

    HUI3 0.19 0.44 0.25

    SF-6D 0.55 0.68 0.13

    Source: Pickard et al. 2004; AS Pickard, personal communication, October 27, 2006.


    Construct validity and responsiveness in recovery after stroke cont l.jpg
    Construct Validity and Responsiveness in Recovery After Stroke, cont.

    Mean Score: Baseline 6 Months

    Measure

    HUI3 Speech 0.83 0.92

    HUI3 Ambulation 0.41 0.68

    HUI3 Dexterity 0.51 0.79

    HUI3 Emotion 0.83 0.92

    HUI3 Vision 0.91 0.90

    SF Physical Func. 19 43

    SF Role Physical 8 34

    SF Role Emotional 48 69


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    Construct Validity and Responsiveness in Recovery After Stroke, cont.

    EQ-5D, % with Problems by Dimension

    Baseline 6 Months

    NoSomeUnableNoSomeUnable

    Mobility:

    17 45 38 40 49 11

    Anxiety/Depression:

    35 60 4 61 37 2


    Construct validity and responsiveness in recovery after stroke cont65 l.jpg
    Construct Validity and Responsiveness in Recovery After Stroke, cont.

    Standardized Response Mean QALYs Gained

    EQ-5D (UK) 0.84 0.16

    SF-6D 0.87 0.06

    HUI3 0.78 0.12

    Note: Standardized Response Mean = change/standard deviation of change scores: QALYs = quality-adjusted life years


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    Overall Gain in Utility Associated with Elective THA Stroke, cont.

    • SF-6D: 0.10

    • Standard Gamble 0.16

    • HUI2 0.22

    • HUI3 0.23

    Source: Feeny et al. 2004.


    Evidence on floor and ceiling effects l.jpg
    Evidence on Floor and Ceiling Effects Stroke, cont.

    • Community Sample, York: PH 49% EQ-5D; 25% HUI3 (Macran et al. 2003)

    • Community Sample, Sweden: PH 43% EQ-5D; among those, 32% report occasional problems for mental health and 23% report musculoskeletal pain (Nordlund et al. 2005)

    • Asthma trials: PH 25% EQ-5D; < 1% SF-6D;

      % below utility score of 0.5: 27% EQ-5D; 20% SF-6D (Szende et al. 2004)


    Evidence on floor and ceiling effects cont l.jpg
    Evidence on Floor and Ceiling Effects, cont. Stroke, cont.

    • EXCITE Trial, HUI3, % at top level by attribute: 11 to ~50%; SF-6D, 5 to 35% (Hatoum et al. 2004)

    • % at Floor: HUI3, 0 to 8%; SF-6D, 2 to 40%

    • Change score from baseline: SF-6D, 0.08; HUI3, 0.15

    • Differences between SF-6D and HUI3 scores more pronounced below 0.6


    Performance of eq 5d hui2 and hui3 in a us population health survey l.jpg
    Performance of EQ-5D, HUI2, and HUI3 in a US Population Health Survey

    • Random Sample of US population age 18+, conducted in 2002, n = 4048

    • Mean EQ-5D Score 0.87

    • Mean HUI2 Score 0.86

    • Mean HUI3 Score 0.81

    Source: Luo et al. 2005.


    Performance of eq 5d hui2 and hui3 in us population health survey l.jpg
    Performance of EQ-5D, HUI2, and HUI3 in US Population Health Survey

    • Percent of Population in Perfect Health

      EQ-5D 50.1%

      HUI2 19.9%

      HUI3 19.5%

    • Number of Unique Health States:

      EQ-5D 91

      HUI2 355

      HUI3 767

    Source: Luo et al. 2005.


    Slide71 l.jpg
    Results from another US Population Health Survey ages 35-89, conducted 2005-2006, n = 3844 (Fryback et al. forthcoming)

    Measure Time Minimum % in Mean Score

    Score PH for 35-44

    EQ-5D 1.9 min -0.11 36.2 0.89

    HUI 3.4 min

    HUI2 -0.01 10.8 0.87

    HUI3 -0.34 11.4 0.83

    QWB-SA 11.1 min 0.09 0.0 0.67

    SF-6D 7.9 min 0.30 4.3 0.80


    Slide72 l.jpg
    Predictive Validity – Out of Sample: Group-Level Agreement Between Standard Gamble and Multi-Attribute Utility Function Scores for HUI2

    GroupMean Utility ScoreSD

    ELBW, n = 140

    HUI2 0.89 0.14

    Standard Gamble 0.90 0.20

    Controls, n = 124

    HUI2 0.95 0.09

    Standard Gamble 0.91 0.16

    Combined, n = 264

    HUI2 0.92 0.13

    Standard Gamble 0.91 0.16

    Note: ELBW = extremely low birthweight.

    Source: Feeny et al. 2004.


    Slide73 l.jpg
    Predictive Validity – Out of Sample/Group-Level Agreement Between Standard Gamble and Multi-Attribute Utility Function Scores for HUI3

    Mean Difference (HUI3 function minus direct SG score) for 73 HUI3 health states:

    -0.008 per health state, on 0.00 to 1.00 scale

    Mean Absolute Difference:

    0.087

    Overall Standard Deviation:

    0.1032

    Intra-Class Correlation Coefficient (95% CI):

    0.88 (0.49, 0.92)

    Source: Furlong et al. 1998; Feeny et al. 2002.


    Predictive validity mortality l.jpg
    Predictive Validity: Mortality Between Standard Gamble and Multi-Attribute Utility Function Scores for HUI3

    • Statistics Canada Longitudinal National Population Health Survey, 1994/95 and every 2 years thereafter

    • Do Baseline Overall HUI3 Scores Predict Mortality in follow-up through 2002/03?

    • Cox Proportional Hazards Model

    • Control for Standard Determinants of Health at Baseline including Age, Education, Martial Status, Socio-Economic Status, BMI, Smoking, Chronic Conditions, Stress, Physical Activity

    • Analysis of those 65 or older at baseline; separate analyses for males and females


    Predictive validity of bmi and hui3 mortality l.jpg
    Predictive Validity of BMI and HUI3: Mortality Between Standard Gamble and Multi-Attribute Utility Function Scores for HUI3

    Results:

    • For Males, Hazard Rate for HUI3:

      0.6 [0.3, 0.9]

    • For Males, Hazard Rate for BMI < 18.5:

      2.5 [1.2, 4.9]

    • For Females, Hazard Rate for HUI3:

      0.5 [0.3, 0.9]

    • For Females, Hazard Rate for BMI < 18.5:

      2.3 [1.5, 3.6]

    Source: Wilkins 2006.


    Interpreting utility preference based measures of health related quality of life l.jpg
    Interpreting Utility (Preference-Based) Measures of Health Related Quality of Life

    Selected Published Guidelines on Clinically Important Differences/Changes in Utility Scores:

    Furlong et al. 1990, SG scores, 0.10 or more is clearly important

    Samsa et al. 1999, HUI2 scores, 0.02 to 0.04 or more is clearly important

    Grootendorst et al. 2000, HUI3 scores, 0.025 or more is clearly important

    Drummond 2001, HUI3 , 0.03 or more clearly important; 0.01 or more may be important


    Interpreting utility preference based measures of health related quality of life cont l.jpg
    Interpreting Utility (Preference-Based) Measures of Health Related Quality of Life, cont.

    Walters and Brazier (2003, 2005) SF-6D scores, 0.033 or more as important

    Kaplan suggests for QWB scores, 0.03 or more as important

    Marra et al.(2005) suggest 0.03 or more for Eq-5D; provide estimates for SF-6D, EQ-5D, HUI2, and HUI3 ranging from 0.03 to 0.06

    For Visual Analog Scale (Feeling Thermometer), Schunemann et al. 2003 suggest 6 to 8 (out of 100)


    Slide78 l.jpg
    Interpreting Utility (Preference-Based) Measures of Health Related Quality of Life: Tentative Guidelines

    Clinically Important Difference/Change in Utility Score:

    Direct, SG, TTO Scores 0.05

    Overall Multi-attribute Utility Scores 0.03

    Useful for Study Design, Sample Size Calculation

    Caveats:

    Context May Matter

    Cost of Producing Change Matters


    Applications of utility scores in cost effectiveness analysis and cost utility analysis l.jpg
    Applications of Utility Scores in Related Quality of Life: Tentative GuidelinesCost-Effectiveness Analysis and Cost-Utility Analysis

    • Randomized controlled trial of hylan GF-20 for knee osteoarthritis

    • Hylan GF-20 is injected into the knee as a replacement synovial fluid

    • 255 patients, multi-centred, 1-year pragmatic trial in Canada

      Source: Raynauld et al. 2002; Torrance et al. 2002.


    Data collection l.jpg
    Data Collection Related Quality of Life: Tentative Guidelines

    • HRQOL

      • Disease Specific: WOMAC

      • Generic: SF-36

      • Utility: HUI3

    • Costs (societal perspective, related to OA)

    • Data gathered at baseline and at 1, 2, 4, 6, 8, 10, 12 months

    • Data gathered primarily by telephone to minimize protocol driven activities like clinic visits


    Data collection patient feedback l.jpg
    Data Collection: Patient Feedback Related Quality of Life: Tentative Guidelines

    • How clear was the WOMAC? the SF-36? the HUI?

      • Clear or very clear 88% 89% 95%

      • Indifferent 6% 6% 3%

      • Unclear or very 6% 5% 2%

    • Interview (minutes): mean 52; min 22; max 95

    • According to patients:

      • 96% enjoyed the interviews

      • 98% length of interviews reasonable

      • 85% HRQOL and health care resources clear and easy to complete


    Results womac pain score l.jpg

    13 Related Quality of Life: Tentative Guidelines

    12

    11

    Appropriate care

    10

    9

    WOMAC pain score (Likert scale)

    8

    *

    7

    6

    Appropriate care with hylan G-F 20

    5

    4

    0

    10

    6

    8

    4

    12

    Baseline

    1

    2

    Month

    *P = 0.0001

    Results:WOMAC Pain Score


    Results clinical effectiveness l.jpg
    Results: Related Quality of Life: Tentative GuidelinesClinical Effectiveness

    • Primary: Change in mean WOMAC pain score

      Change Baseline Month 12 (% of baseline)

      T 11.35 6.95 –38.41

      C 11.94 10.10 –13.34

      T - C –25.07 (P = 0.0001)


    Results clinical effectiveness84 l.jpg
    Results: Related Quality of Life: Tentative GuidelinesClinical Effectiveness

    • Secondary: Patients Improved

      Percent of Patients Improved

      Treatment 68.5%

      Control 40.0%

      T - C 28.5% (P = 0.0001)


    Results costs l.jpg
    Results: Related Quality of Life: Tentative GuidelinesCosts

    Annual Costs per Patient (1999 Canadian $)

    Societal Perspective

    Exchange rate in 1999: Cdn $1.00 = US $0.67

    Treatment $2125

    Control $1415

    T – C $710


    Results cost effectiveness l.jpg
    Results: Related Quality of Life: Tentative GuidelinesCost-Effectiveness

    Incremental cost/pt = $710 (Canadian)

    Incremental effectiveness/pt = 0.28 pts improved

    Incr’l cost-effectiveness ratio =$710 / 0.28

    = $2,505/pt improved


    Results sf 36 l.jpg
    Results: Related Quality of Life: Tentative GuidelinesSF-36

    Change (% from baseline)

    T C T - C

    Physical Component Summary (PCS) 20.31 1.07 19.24*

    Mental Component Summary (MCS) 11.53 5.40 6.13

    *p < 0.0001


    Results hui3 l.jpg
    Results: Related Quality of Life: Tentative GuidelinesHUI3

    Change (absolute change from baseline)

    T C T – C

    HUI3 total score 0.13 0.03 0.10 (p<0.0001)


    A typical patient profile for the hui3 score showing area under the curve calculation for qalys l.jpg
    A Typical Patient Profile for the HUI3 Score Related Quality of Life: Tentative GuidelinesShowing Area-Under-the-Curve Calculationfor QALYs

    1

    Patient utility score

    0

    0

    1

    2

    4

    6

    8

    10

    12

    Baseline

    Time (months)


    Health utilities index 3 l.jpg
    Health Utilities Index 3 Related Quality of Life: Tentative Guidelines

    0.20

    0.20

    Appropriate care + hylan G-F 20

    0.15

    0.15

    Change from baseline in HUI3 score

    0.10

    0.10

    s= 0.071 QALYs

    kdfjdkfjdkfjkdjf

    0.05

    0.05

    Appropriate care

    0

    12

    0

    1

    2

    4

    6

    8

    10

    Months


    Results cost utility l.jpg
    Results: Related Quality of Life: Tentative GuidelinesCost-Utility

    Incremental cost/pt=$710 (Canadian)

    Incremental QALY/pt = 0.071 QALYs gained

    Incr’l cost-utility ratio =$710 / 0.071

    = $10,000/QALY gained


    Cumulative distribution of hui3 scores by the type of residence and disability level l.jpg
    Cumulative Distribution of HUI3 Scores by the Type of Residence and Disability Level

    Adjusted for age and gender according to the structure by age and gender of private households population.

    Source: Statistics Canada, 1996-97 National Population Health Survey


    Slide93 l.jpg

    Mean HUI3 calculated from the 1996 - 97 National Population Health Survey (Canada)

    Source: Statistics Canada


    Slide94 l.jpg

    Criteria for Selecting an Appropriate Measure for your Study Health Survey (Canada)

    Advantages of Multi-Attribute Approach

    • Low Respondent Burden

    • Inexpensive to Use

    • Availability of Standardized Questionnaires in Multiple Formats, Multiple Languages, Algorithms, Manuals, etc.

    • Use of Community Preferences Facilitates Broad Comparison (Reference Case)

    • Interpretation of overall HRQL scores enhanced by availability of single-attribute utility scores for each dimension of health status

    • Interpretation Enhanced by the Availability of Data on Population Norms

      Disadvantages of MA Approach

    • Health-Status Description may omit Dimensions or Levels that are Important in a Particular Context

    • Multi-Attribute Measure May not be as Responsive as Specific Measure


    Slide95 l.jpg

    Criteria for Selecting, cont’d Health Survey (Canada)

    Psychometric, Clinimetric, and Utility Measures are often Complementary:

    • Utility Measures Focus on Cardinal Value of Health States

    • Utility Measures Provide Scores on the Generic Dead =0.00 to Perfect Health = 1.00 Scale

      Useful for:

    • Individual Patients, Clinical Decision Making

    • Clinical Groups, Clinical Policy

    • Informing Management of Patients

    • Informing Clinical Policy

    • Population Health

    • Informing Resource Allocation Decisions/Economic Evaluation

    • Health Technology Assessment


    Report on results from demonstration administration of selected utility measures l.jpg
    Report on Results from Demonstration Administration of Selected Utility Measures

    n Mean Min Max SD

    VAS

    TTO

    SG

    EQ-5DUS

    EQ-5DUK

    HUI2

    HUI3

    SF-6D


    Summary l.jpg
    Summary Selected Utility Measures

    • Utility Measures Useful to Assess Outcome and for Economic Evaluation/Health Technology Assessment

    • Broad Comparisons; Integrate Mortality and Morbidity

    • Often Useful to Complement Utility Measures with Specific Measures


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