Background. Cost utility analysis permits the comparison
of disparate health services by measuring outcomes in
comparable units, namely, quality-adjusted life-years,
which equal life-years times the utility of the health state.
However, comparability is compromised when different
utility instruments predict different utilities for the same
health state. The present paper measures the extent of,
and reason for, differences between the utilities predicted
by the EQ-5D-5L, SF-6D, HUI 3, 15D, QWB, and AQoL-8D.
Methods. Data were obtained from patients in seven disease
areas and members of the healthy public in six countries.
Differences between public and patient utilities were
estimated using each of the instruments. To explain discrepancies
between the estimates, the measurement scales
and content of the instruments were compared. The sensitivity
of instruments to independently measured health dimensions
was measured in pairwise comparisons of all
combinations of the instruments. Results. The difference
between public and patient utilities varied with the choice
of instrument by more than 50% for every disease group
and in four of the seven groups by more than 100%. Discrepancies
were associated with differences in both the
instrument content and their measurement scales. Pairwise
comparisons of instruments found that variation in
the sensitivity to physical and psychosocial dimensions
of health closely reflected the items in the instrument’s
descriptive systems. Discussion. Results indicate that instruments
measure related but different constructs. They
imply that commonly used instruments systematically discriminate
against some classes of services, most notably
mental health services. Differences in the instrument
scales imply the need for transformations between the instruments
to increase the comparability of measurement.
Key words: utility measurement; multiattribute utility;
cost utility analysis; economic evaluation
Developed interpersonal skill
Background. Cost utility analysis permits the comparisonof disparate health services by measuring outcomes incomparable units, namely, quality-adjusted life-years,which equal life-years times the utility of the health state.However, comparability is compromised when differentutility instruments predict different utilities for the samehealth state. The present paper measures the extent of,and reason for, differences between the utilities predictedby the EQ-5D-5L, SF-6D, HUI 3, 15D, QWB, and AQoL-8D.Methods. Data were obtained from patients in seven diseaseareas and members of the healthy public in six countries.Differences between public and patient utilities wereestimated using each of the instruments. To explain discrepanciesbetween the estimates, the measurement scalesand content of the instruments were compared. The sensitivityof instruments to independently measured health dimensionswas measured in pairwise comparisons of allcombinations of the instruments. Results. The differencebetween public and patient utilities varied with the choiceof instrument by more than 50% for every disease groupand in four of the seven groups by more than 100%. Discrepancieswere associated with differences in both theinstrument content and their measurement scales. Pairwisecomparisons of instruments found that variation inthe sensitivity to physical and psychosocial dimensionsof health closely reflected the items in the instrument’sdescriptive systems. Discussion. Results indicate that instruments
measure related but different constructs. They
imply that commonly used instruments systematically discriminate
against some classes of services, most notably
mental health services. Differences in the instrument
scales imply the need for transformations between the instruments
to increase the comparability of measurement.
Key words: utility measurement; multiattribute utility;
cost utility analysis; economic evaluation
Developed interpersonal skill
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