Multiattribute and Single-Attribute Utility Functions for... : Medical Care (original) (raw)

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Multiattribute and Single-Attribute Utility Functions for the Health Utilities Index Mark 3 System

Feeny, David PhD*,†; Furlong, William MSc†,∥; Torrance, George W. PhD†; Goldsmith, Charles H. PhD§,#; Zhu, Zenglong MA¶; Depauw, Sonja MESc**; Denton, Margaret PhD††; Boyle, Michael PhD‡‡

*From the Institute of Health Economics; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta; and †Health Utilities Inc., Dundas, Ontario.

‡From Innovus Research Inc., Burlington, Ontario.

§From the Centre for the Evaluation of Medicines, St. Joseph's Hospital, Hamilton, Ontario.

¶From the Prudential Insurance Company of America, Newark, New Jersey.

From the ∥Centre for Health Economics and Policy Analysis; #Department of Clinical Epidemiology and Biostatistics; the **Centre for Minimal Access Surgery, Department of Surgery; the ††Office of Gerontological Studies and Department of Sociology; and the ‡‡Department of Psychiatry, McMaster University McMaster University, Hamilton, Ontario.

Support from Ontario (Canada) Ministry of Health grant #04020; Natural Science and Engineering Research Council grant #10020; grants from Astra Pharma Inc., Bayer Inc. Boehringer-Ingelheim, Bristol-Myers Squibb, Burroughs Wellcome Inc., Eli Lilly, Glaxo Canada Inc., Janssen Pharmaceutica Research Foundation, Nordic Merrell Dow Research, Ortho-McNeil and CILAG, Pharmaceutical Manufacturers Association of Canada (Health Economics Committee), and Sandoz Canada Inc. are gratefully acknowledged. The funding sources played no role in the design, interpretation, or analysis of the project and have not reviewed or approved of this manuscript. Salary support for David Feeny is provided by an award from the Canadian Institutes of Health Research/Rx & D Program.

An earlier version of the paper was presented at the 4th Annual Conference of the International Society for Quality of Life Research, Vienna, November 5 to 9, 1997.

Address correspondence and reprint requests to: David Feeny, Institute of Health Economics, #1200, 10405 Jasper Ave, Edmonton, AB T5J 3N4 Canada. E-mail: [email protected]

Received July 24, 2001; initial review September 29, 2001; accepted October 1, 2001.

(Med Care 2002;40:113-128)

Abstract

Background.

The Health Utilities Index Mark 3 (HUI3) is a generic multiattribute preference-based measure of health status and health-related quality of life that is widely used as an outcome measure in clinical studies, in population health surveys, in the estimation of quality-adjusted life years, and in economic evaluations. HUI3 consists of eight attributes (or dimensions) of health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain with 5 or 6 levels per attribute, varying from highly impaired to normal.

Objectives.

The objectives are to present a multiattribute utility function and eight single-attribute utility functions for the HUI3 system based on community preferences.

Study Design.

Two preference surveys were conducted. One, the modeling survey, collected preference scores for the estimation of the utility functions. The other, the direct survey, provided independent scores to assess the predictive validity of the utility functions.

Measures.

Preference measures included value scores obtained on the Feeling Thermometer and standard gamble utility scores obtained using the Chance Board.

Respondents.

A random sample of the general population (≥16 years of age) in Hamilton, Ontario, Canada.

Results.

Estimates were obtained for eight single-attribute utility functions and an overall multiattribute utility function. The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88.

Conclusions.

The HUI3 scoring function has strong theoretical and empirical foundations. It performs well in predicting directly measured scores. The HUI3 system provides a practical way to obtain utility scores based on community preferences.