Incorporating Mortality in Health Utility Measures

2020 ◽  
Vol 40 (7) ◽  
pp. 862-872
Author(s):  
Barry Dewitt ◽  
George W. Torrance
Keyword(s):  
Health Utility Index ◽  
Health Utility ◽  
Quality Adjusted Life Year ◽  
The State ◽  
Multidimensional Space ◽  
Health States ◽  
Utility Systems ◽  
Design Choice ◽  
Scale Properties ◽  
Utility Measures

The creation of multiattribute health utility systems requires design choices that have profound effects on the utility model, many of which have been documented and studied in the literature. Here we describe one design choice that has, to the best of our knowledge, been unrecognized and therefore ignored. It can emerge in any multiattribute decision analysis in which one or more essential outcomes cannot be described in terms of the multiattribute space. In health applications, the state of being dead is such an outcome. When the remaining health is conceptualized as a multidimensional space, determining the utility of the state of being dead requires using the interval-scale properties of cardinal utility, combined with elicited utilities for the state of being dead and the all-worst state, to produce a utility function in which the state of being dead has a utility of 0 and full health has a utility of 1 (i.e., the quality-adjusted life-year scale). Although previously unrecognized, there are two approaches to accomplish that step, and they produce different results in almost all cases. As a corollary, the choice of approach determines the proportion of states rated as worse than dead by the system. For example, in the Health Utility Index 3 (HUI3), the method used classifies 78% of the 972,000 unique health states in the classification system as worse than dead, and that proportion increases to 85% when the HUI3 is recalculated using the alternative approach. Studies of populations with significant morbidity are the most likely to be sensitive to the design choice. Those who design utility measures should be aware that they are using a researcher degree of freedom when they decide how to scale the state of being dead.

Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

2020 ◽  
Author(s):  
Ping Zhang ◽  
Karen M. Atkinson ◽  
George Bray ◽  
Haiying Chen ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Health Utility Index ◽  
Health Benefit ◽  
Cost Effective ◽  
Health Utility ◽  
Health Care Expenditures ◽  
Quality Adjusted Life Year

<b>OBJECTIVE </b>To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. <p><b>RESEARCH DESIGN AND METHODS</b> Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. </p> <p><b>RESULTS </b><a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. </p> <p><b>Conclusions </b>Whether<b> </b>ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions. </p>

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.

scholarly journals A monetary valuation of the quality of life loss associated with pathological gambling: an application using a health utility index

2014 ◽  
pp. 1 ◽  
Author(s):  
Dimitri Kohler
Keyword(s):  
Quality Of Life ◽  
Pathological Gambling ◽  
Health Utility Index ◽  
Pathological Gambler ◽  
Health Utility ◽  
Quality Adjusted Life Year ◽  
Gambling Addiction ◽  
Tobit Regression ◽  
Pathological Gamblers

This study estimates the Health Related Quality of Life (HRQoL) costs of gambling addiction. Pathological gamblers were recruited from treatment centers in Western Switzerland. The difference in HRQoL between pathological gamblers (n=52) and a sample drawn from the general population (n=93) was measured through a multi-item instrument, the SF-6D. We used a tobit regression to estimate the effect of pathological gambling on HRQoL, controlling for comorbidities and age. Finally, to obtain a monetary value of the HRQoL loss attributable to gambling addiction, we applied an existing value of a life year estimate. Results showed that pathological gambling is significantly associated with a decrease in the quality of life by 0.076 quality adjusted life year (QALY). The resulting cost per pathological gambler and per year was estimated at CHF 3,830. This study suggests that ignoring quality of life costs results in an underestimation of the social burden of gambling addiction.

Value of life and time: A survivorship perspective.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18298-e18298
Author(s):  
Jennifer M. Hinkel ◽  
Daniel B. Sexton ◽  
Justine Egan-Kunicki
Keyword(s):  
Online Survey ◽  
Full Range ◽  
Health Utility ◽  
Hematologic Malignancies ◽  
Quality Adjusted Life Year ◽  
Value Of Life ◽  
Health States ◽  
Convenience Sample ◽  
Potential Health ◽  
Life Years

e18298 Background: Common tools to quantify value of life years after a cancer diagnosis include the Quality Adjusted Life Year (QALY). This measure is partly based on health utility states derived from Quality of Life (QoL) survey instruments such as the EQ-5D. Research has identified shortcomings in applying the QALY, including the potential for underestimating value. QoL surveys may fail to capture the full range of potential health states, or the values derived may fail to reflect patient perspectives of value. Methods: An online survey was piloted with a convenience sample of cancer survivors via two US survivor Facebook groups over two weeks in Jan. 2017 to explore these themes. Results: 116 complete responses were analyzed (of 123 respondents). Original diagnoses included solid tumors and hematologic malignancies, and respondents were between one and 32 years post-diagnosis (PoD). Most (101, 87%) had completed active treatment. A majority (85, 73%) rated PoD years as having more value than years pre-diagnosis (PreD). 83% (98) indicated that they felt their time is more valuable since their diagnosis. While the majority of respondents (57%) assigned a lower value to the 12 months immediately following diagnosis compared to the value of a PreD year, a majority (55%) also valued the most recent twelve months to have equal or greater value than a PreD year. Many assigned higher valuations to PoD years even when simultaneously reporting limitations in Activities of Daily Living (ADLs). Conclusions: Comparing survivor valuations of PoD life years to valuations derived by utility state instruments has not been heavily researched. This survey generates additional hypotheses. First, assuming PoD years hold lower value than PreD years may underestimate value compared to a survivor’s view. Second, QoL instruments may not be capturing positive changes in PoD years, some of which have been documented in psychology research, such as Post-Traumatic Growth or increased feeling of meaningfulness. Further investigation is imperative to ensure that value determinations have a solid evidentiary basis and reflect patient-centered viewpoints, particularly as the “value debate” influences patient access to care.

scholarly journals Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

2020 ◽  
Author(s):  
Ping Zhang ◽  
Karen M. Atkinson ◽  
George Bray ◽  
Haiying Chen ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Health Utility Index ◽  
Health Benefit ◽  
Cost Effective ◽  
Health Utility ◽  
Health Care Expenditures ◽  
Quality Adjusted Life Year

<b>OBJECTIVE </b>To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. <p><b>RESEARCH DESIGN AND METHODS</b> Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. </p> <p><b>RESULTS </b><a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. </p> <p><b>Conclusions </b>Whether<b> </b>ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions. </p>

Trends in Partial Disability-Free Life Expectancy between the Ages of 45 and 70 in Canada, 2000–2014

2022 ◽  
pp. 1-7
Author(s):  
Judith Lefebvre ◽  
Yves Carrière
Keyword(s):  
Life Expectancy ◽  
Health Utility Index ◽  
Health Utility ◽  
Canadian Community Health Survey ◽  
Retirement Age ◽  
Utility Index ◽  
Community Health Survey ◽  
Recent Trends ◽  
Disability Free Life Expectancy ◽  
Sullivan Method

Abstract To better evaluate the benefits of a possible increase in the normal retirement age, this article proposes to examine recent trends in the health status of Canadians between 45 and 70 years of age. Using the Sullivan method, trends from 2000 to 2014 in partial disability-free life expectancy (PDFLE) between the ages of 45 and 70 years are computed. Disability is estimated using attributes of the Health Utility Index correlated with the capacity to work, and is looked at by level of severity. Data from the Canadian Community Health Survey were used to estimate the prevalence of disability. Results reveal a slight increase in partial life expectancy between the ages of 45 and 70, and a larger number of those years spent in poor health since the beginning of the 2000s. Hence, this study brings no evidence in support of the postponement of the normal retirement age if this policy were solely based on gains in life expectancy.

scholarly journals Preferences and Utilities for Health States after Treatment of Olfactory Groove Meningioma: Endoscopic versus Open

2017 ◽  
Vol 78 (04) ◽  
pp. 315-323 ◽  
Author(s):  
Christopher Yao ◽  
Alyssa Kahane ◽  
Eric Monteiro ◽  
Fred Gentili ◽  
Gelareh Zadeh ◽  
...  
Keyword(s):  
Watchful Waiting ◽  
Health Utility ◽  
Cost Utility ◽  
Endoscopic Approach ◽  
Older Individuals ◽  
Health States ◽  
Stereotactic Radiation ◽  
Olfactory Groove ◽  
Transcranial Approach ◽  
Utility Scores

Objectives The purpose of this study is to report health utility scores for patients with olfactory groove meningiomas (OGM) treated with either the standard transcranial approach, or the expanded endonasal endoscopic approach. Design The time trade-off technique was used to derive health utility scores. Setting Healthy individuals without skull base tumors were surveyed. Main Outcome Measures Participants reviewed and rated scenarios describing treatment (endoscopic, open, stereotactic radiation, watchful waiting), remission, recurrence, and complications associated with the management of OGMs. Results There were 51 participants. The endoscopic approach was associated with higher utility scores compared with an open craniotomy approach (0.88 vs. 0.74; p < 0.001) and watchful waiting (0.88 vs.0.74; p = 0.002). If recurrence occurred, revision endoscopic resection continued to have a higher utility score compared with revision open craniotomy (0.68; p = 0.008). On multivariate analysis, older individuals were more likely to opt for watchful waiting (p = 0.001), whereas participants from higher income brackets were more likely to rate stereotactic radiosurgery with higher utility scores (p = 0.017). Conclusion The endoscopic approach was associated with higher utility scores than craniotomy for primary and revision cases. The present utilities can be used for future cost-utility analyses.

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