Health Utility Measurement

2011 ◽  
pp. 787-813 ◽  
Author(s):  
Donna Rowen ◽  
John Brazier
Keyword(s):  
Economic Evaluation ◽  
Health Utility ◽  
Health State ◽  
Health States ◽  
Health State Description ◽  
Utility Measurement ◽  
Current State ◽  
Increasing Demand ◽  
Demand For Health

Measuring and valuing health is a major component of economic evaluation, meaning that health utility measurement has been growing in popularity in recent years due to the increasing demand for health state values in economic models and evaluations. The main issues in health utility measurement are how to describe health states, how to value the health state description and whose values should be used. This article briefly outlines these main issues and then focuses on recent methodological developments in health utility measurement. It assesses the current state of health utility measurement and discusses the question of assessment of a health state to be used in economic evaluation. The discussion whether experience utility should be used rather than conventional preference-based utility raises important issues about perspective and the role of various factors.

From Clinical Outcomes to Health Utilities: The Role of Mapping to Bridge the Evidence Gap

2019 ◽  
Author(s):  
Mónica Hernández Alava
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Economic Evaluation ◽  
Health Utility ◽  
Health State ◽  
Health States ◽  
Descriptive System ◽  
Healthcare Technologies ◽  
Health State Utility Values

The assessment of health-related quality of life is crucially important in the evaluation of healthcare technologies and services. In many countries, economic evaluation plays a prominent role in informing decision making often requiring preference-based measures (PBMs) to assess quality of life. These measures comprise two aspects: a descriptive system where patients can indicate the impact of ill health, and a value set based on the preferences of individuals for each of the health states that can be described. These values are required for the calculation of quality adjusted life years (QALYs), the measure for health benefit used in the vast majority of economic evaluations. The National Institute for Health and Care Excellence (NICE) has used cost per QALY as its preferred framework for economic evaluation of healthcare technologies since its inception in 1999. However, there is often an evidence gap between the clinical measures that are available from clinical studies on the effect of a specific health technology and the PBMs needed to construct QALY measures. Instruments such as the EQ-5D have preference-based scoring systems and are favored by organizations such as NICE but are frequently absent from clinical studies of treatment effect. Even where a PBM is included this may still be insufficient for the needs of the economic evaluation. Trials may have insufficient follow-up, be underpowered to detect relevant events, or include the wrong PBM for the decision- making body. Often this gap is bridged by “mapping”—estimating a relationship between observed clinical outcomes and PBMs, using data from a reference dataset containing both types of information. The estimated statistical model can then be used to predict what the PBM would have been in the clinical study given the available information. There are two approaches to mapping linked to the structure of a PBM. The indirect approach (or response mapping) models the responses to the descriptive system using discrete data models. The expected health utility is calculated as a subsequent step using the estimated probability distribution of health states. The second approach (the direct approach) models the health state utility values directly. Statistical models routinely used in the past for mapping are unable to consider the idiosyncrasies of health utility data. Often they do not work well in practice and can give seriously biased estimates of the value of treatments. Although the bias could, in principle, go in any direction, in practice it tends to result in underestimation of cost effectiveness and consequently distorted funding decisions. This has real effects on patients, clinicians, industry, and the general public. These problems have led some analysts to mistakenly conclude that mapping always induces biases and should be avoided. However, the development and use of more appropriate models has refuted this claim. The need to improve the quality of mapping studies led to the formation of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Mapping to Estimate Health State Utility values from Non-Preference-Based Outcome Measures Task Force to develop good practice guidance in mapping.

scholarly journals The QALY is ableist: on the unethical implications of health states worse than dead

2021 ◽  
Author(s):  
Paul Schneider
Keyword(s):  
Economic Evaluation ◽  
Health Economic Evaluation ◽  
Health State ◽  
Worth Living ◽  
Allocation Of Resources ◽  
Health It ◽  
Healthy Individuals ◽  
Ethical Aspects ◽  
Health States ◽  
The Times

Abstract Introduction A long-standing criticism of the QALY has been that it would discriminate against people in poor health: extending the lives of individuals with underlying health conditions gains fewer QALYs than extending the lives of ‘more healthy’ individuals. Proponents of the QALY counter that this only reflects the general public’s preferences and constitutes an efficient allocation of resources. A pivotal issue that has thus far been overlooked is that there can also be negative QALYs. Methods and results Negative QALYs are assigned to the times spent in any health state that is considered to be worse than dead. In a health economic evaluation, extending the lives of people who live in such states reduces the overall population health; it counts as a loss. The problem with this assessment is that the QALY is not based on the perspectives of individual patients—who usually consider their lives to be well worth living—but it reflects the preferences of the general public. While it may be generally legitimate to use those preferences to inform decisions about the allocation of health care resources, when it comes to states worse than dead, the implications are deeply problematic. In this paper, I discuss the (un)ethical aspects of states worse than dead and demonstrate how their use in economic evaluation leads to a systematic underestimation of the value of life-extending treatments. Conclusion States worse than dead should thus no longer be used, and a non-negative value should be placed on all human lives.

scholarly journals Setting Dead at Zero: Applying Scale Properties to the QALY Model

2018 ◽  
Vol 38 (6) ◽  
pp. 627-634 ◽  
Author(s):  
Bram Roudijk ◽  
A. Rogier T. Donders ◽  
Peep F.M. Stalmeier
Keyword(s):  
Decision Making ◽  
Research Question ◽  
Health Utility ◽  
Discrete Choice Experiments ◽  
Health State ◽  
Ratio Scale ◽  
Health States ◽  
A Value ◽  
Scale Properties ◽  
Utility Scale

Introduction. Scaling severe states can be a difficult task. First, the method of measurement affects whether a health state is considered better or worse than dead. Second, in discrete choice experiments, different models to anchor health states on 0 (dead) and 1 (perfect health) produce varying amounts of health states worse than dead. Research Question. Within the context of the quality-adjusted life year (QALY) model, this article provides insight into the value assigned to dead and its consequences for decision making. Our research questions are 1) what are the arguments set forth to assign dead the number 0 on the health–utility scale? And 2) what are the effects of the position of dead on the health–utility scale on decision making? Methods. A literature review was conducted to explore the arguments set forth to assign dead a value of 0 in the QALY model. In addition, scale properties and transformations were considered. Results. The review uncovered several practical and theoretical considerations for setting dead at 0. In the QALY model, indifference between 2 health episodes is not preserved under changes of the origin of the duration scale. Ratio scale properties are needed for the duration scale to preserve indifferences. In combination with preferences and zero conditions for duration and health, it follows that dead should have a value of 0. Conclusions. The health–utility and duration scales have ratio scale properties, and dead should be assigned the number 0. Furthermore, the position of dead should be carefully established, because it determines how life-saving and life-improving values are weighed in cost–utility analysis.

Nanocomputing in Cognitive Radio Networks to Improve the Performance

2014 ◽  
pp. 1020-1040
Author(s):  
Yenumula B. Reddy
Keyword(s):  
Cognitive Radio ◽  
Real Time ◽  
Cognitive Radio Networks ◽  
Distributed Processing ◽  
Radio Networks ◽  
Future Research ◽  
Current State ◽  
Real Time Applications ◽  
Increasing Demand

Computing and communications are central issues in cognitive radio networks. The cognitive users are increasing exponentially and the available spectrum resource is constant. Therefore, efficient usage of spectrum through cognitive radio networks is essential. The real-time communications in cognitive radio networks with increasing demand for spectrum is possible through nanocomputing. Nanocomputing is the computing with thousands or millions of computers at the same time to gain more power for less money within minimum possible time. Therefore, the future research requires real-time communications using interconnected nanolevel computer devices. This spectrum sensing application is ideal for nanotechnology implementation because intensive computations are needed. Without nanocomputing it might be infeasible to implement sensing and analysis in real-time for cognitive radio networks with the current available computing power. Therefore, we need complicated distributed processing schemes to achieve our goals and nanocomputing is the best answer. The contribution includes the current state of nanotechnology, the cognitive radio networks, role of nanotechnology in cognitive radio networks, and building the model using nanotechnology for real-time applications.

Feasibility of a Health Utility Assessment Platform in a Hemodialysis Outpatient Setting (Preprint)

2021 ◽  
Author(s):  
Adeboye A Adejare Jr ◽  
Heather J Duncan ◽  
Geoffrey R. Motz ◽  
Silvi Shah ◽  
Charuhas V. Thakar ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Assessment Tool ◽  
Health Utility ◽  
Assessment Process ◽  
Health State ◽  
Post Intervention ◽  
Health States ◽  
General Group ◽  
Utility Assessment ◽  
Clinic Setting

BACKGROUND Background: Patients with End-Stage Kidney Disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is through the use of Hepatitis-C Viremic (HCV) kidneys. OBJECTIVE Objective: As preparation for developing a shared decision-making tool to assist ESKD patients with the decision whether to accept an HCV-viremic kidney transplant, we first wanted to assess the feasibility of using the Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting. Secondary goals were to collect ESKD patients’ utilities and to explore whether use of race-matched vs race-mismatched exemplars impacted knowledge gained during the assessment process. METHODS Methods: We used the Gambler II to elicit utilities for ESKD-related health states: hemodialysis, kidney transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney. We created race exemplar video clips describing these health states and randomly assigned patients into the race-matched or race-mismatched video arms. We obtained utilities for these 3 health states from each patient, and we evaluated knowledge about ESKD and HCV-associated health conditions with pre- and post-intervention knowledge assessments. RESULTS Results: 63 hemodialysis patients from 4 outpatient Dialysis Center Inc. sites completed the study. Mean adjusted standard gamble utilities for hemodialysis, transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney were 82.5, 89, and 75.5 respectively. General group knowledge assessment scores improved by 10 points (p < 0.05) following utility assessment process. CONCLUSIONS Conclusion: Using The Gambler II to collect ESKD patients’ utilities in an ambulatory dialysis clinic setting proved feasible. In addition, educational information about health states provided as part of the utility assessment process tool improved patients’ knowledge and understanding about ESKD-related health states and implications of organ transplantation with HCV-viremic kidneys. Wide variation in patient health state utilities reinforces the importance of incorporating patients’ preferences into decisions regarding use of HCV-viremic kidneys for transplantation

scholarly journals Automated Tool for Health Utility Assessments: The Gambler II

2020 ◽  
Vol 5 (1) ◽  
pp. 238146832091430
Author(s):  
Adeboye A. Adejare ◽  
Mark H. Eckman
Keyword(s):  
Assessment Tool ◽  
Health Utility ◽  
Assessment Process ◽  
Health State ◽  
Health States ◽  
Convenience Sample ◽  
Utility Assessment ◽  
Clinical Encounters ◽  
System Usability Scale ◽  
Before And After

Background. The Gambler II is a web-based utility assessment tool supporting visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO) utility assessments. It contains novel features, including an easy to use project development authoring tool and use of multimedia clips for health state descriptions. Objectives. Evaluate the usability and understandability of the patient-facing side of The Gambler. Investigate the feasibility of using The Gambler and evaluate its impact on patient knowledge regarding the relevant health states. Materials and Methods. We used The Gambler to assess utilities on a convenience sample of 55 users for common long-term complications of type 2 diabetes mellitus: diabetic neuropathy, diabetic retinopathy, and diabetic foot infection requiring transmetatarsal amputation. Using VAS, SG, and TTO, we collected metadata, such as time spent on each assessment and the entire assessment process. We evaluated usability with an adaptation of the System Usability Scale survey and understandability. We evaluated impact on knowledge gained through knowledge assessments about these complications before and after use of The Gambler. Results. Overall satisfaction with The Gambler was high, 4.02 on a 5-point scale. Usability rated highly at 84.93 on a normalized scale between 0 and 100. Knowledge scores increased significantly following use of The Gambler from pretest mean of 68% to posttest mean of 76% ( P < 0.01). Average time using the software: ∼7½ minutes. Conclusions. The Gambler is an easy to use and understand computer-based tool for utility assessment. It is feasible to use within clinical encounters to support shared decision making, and it has unique features that make it a powerful tool for investigators interested in research on health utilities.

ANALYSIS OF APPLICATION OF BLOCKCHAIN TECHNOLOGIES FOR THE BANKING SECTOR

2017 ◽  
Author(s):  
Svitlana Ilkovych ◽  
◽  
Maryna Korol ◽  
Keyword(s):  
Banking Sector ◽  
Blockchain Technology ◽  
Current State ◽  
Global Banking ◽  
Banking Institutions ◽  
Pros And Cons ◽  
Further Development

The article considers the essence of blockchain technology and the possibility of its application in the banking sector. The current state of development and application of blockchain technologies in various industries is analyzed. The pros and cons of using blockchain technologies for the banking sector are identified. Emphasis is placed on the role of blockchain technologies in the further development of the banking sector. The most promising directions of development of this technology are considered. Particular attention is paid to examples of the use of blockchain technology by global banking institutions.

Current state and main directions of preservation and strengthening of health of the working population of Russia

2020 ◽  
pp. 527-532 ◽  
Author(s):  
I. V. Bukhtiyarov
Keyword(s):  
Working Conditions ◽  
Russian Federation ◽  
Production Environment ◽  
Working Population ◽  
Industrial Enterprises ◽  
The Past ◽  
Production Factors ◽  
Current State ◽  
The Russian Federation

The article presents the results of the analysis of health, working conditions and prevalence of adverse production factors, the structure of the detected occupational pathology in the working population of the Russian Federation. The article presents Statistical data on the dynamics of the share of workplaces of industrial enterprises that do not meet hygienic standards, occupational morbidity in 2015-2018 for the main groups of adverse factors of the production environment and the labor process. The indicators of occupational morbidity over the past 6 years in the context of the main types of economic activity, individual subjects of the Russian Federation, classes of working conditions, levels of specialized occupational health care. The role of the research Institute of occupational pathology and occupational pathology centers in solving organizational, methodological and practical tasks for the detection, treatment, rehabilitation and prevention of occupational diseases is shown. The basic directions of activity in the field of preservation and strengthening of health of workers, and also safety at a workplace are defined.

The Role of Archpriest Eugene Popov in Enhancing of the Anglican-Orthodox Dialog

2020 ◽  
pp. 71-84
Author(s):  
Ярослав Очканов
Keyword(s):  
State Level ◽  
Structural Features ◽  
Russian Orthodox ◽  
Church Community ◽  
Anglican Church ◽  
Current State ◽  
The Church

Статья посвящена исследованию малоизученной стороны деятельности видного русского священнослужителя протоиерея Евгения Попова, бывшего с 1842 по 1875 гг. настоятелем русской посольской церкви в Лондоне. Его служение на Английской земле совпало с углублением диалога между Русской Православной и Англиканской церквами, явившегося следствием религиозных преобразований в Англии в 1830 - 1840-е гг. Отец Евгений в рассматриваемый период фактически стал связующим звеном между русским церковноначалием и англиканами - инициаторами единения двух Церквей. Он проделал огромную работу по популяризации православия в Англии и много сделал для ознакомления русской церковной общественности с вероучением и структурными особенностями англиканства. Материалом для исследования послужили, прежде всего, письма протоиерея Евгения Попова обер-прокурорам Святейшего Синода Н. А. Протасову и А. П. Толстому. Эти документы являются своеобразными отчётами о современном состоянии Англиканской Церкви, о религиозных течениях в ней и усилиях, предпринимаемых определёнными церковными кругами в Англии по сближению с православием. Результаты его деятельности имели важное значение в последующие десятилетия, когда англикано-православный диалог вышел на церковно-государственный уровень. The article is devoted to the insufficiently studied aspects of Russian prominent cleric Archpriest Eugene Popov, rector of Russian Embassy Church in London from 1842 to 1875. His Ministry on the English soil coincided with the deepening of the dialogue between the Russian Orthodox and Anglican Churches, which was the result of religious transformations in England in the 1830s and 1840s. Father Eugene in the period under consideration actually became a connecting link between the Russian Church authorities and the anglicans-initiators of the union of the two Churches. He had done a great job by popularizing Orthodoxy in England and by familiarizing the Russian Church community with the doctrine and structural features of Anglicanism. The study, first of all, is based the letters of Archpriest Yevgeny Popov to the chief prosecutors of the Holy Synod N. A. Protasov and A. P. Tolstoy, which were original reports on the current state of the Anglican Church, it’s religious trends, and the efforts made by certain Church circles in England to get closer to Orthodoxy. The fruits of his activities were important in the following decades, when the Anglican-Orthodox dialogue reached the Church-state level.

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