Michael H. Boyle

Multiattribute and single-attribute utility functions for the Health Utilities index mark 3 system

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.

Multi-Attribute Preference Functions

SummaryMulti-attribute utility theory. an extension of conventional utility theory, can be applied to model preference scores for health slates defined by multi-attribute health status classification systems. The type of preference independence among the attributes determines the type of preference function required: additive, multiplicative or multilinear. In addition, the type of measurement instrument used determines the type of preference score obtained: value or utility.Multi-attribute utility theory has been applied to 2 recently developed multi-attribute health status classification systems the Health Utilities Index (HUI) Mark II and Mark III systems. Results are presented for the Mark system, and ongoing research is described for the Mark system. The theory is also discussed in the context of ocher well known multi-attribute systems.The HUI system is an efficient method of determining a general public-based utility score for a specified health outcome or for the health status of an individual. In clinical populations, the scores can be used 10 provide a single summary measure of health-related quality of life. In cost-utility analyses, the scores can be used as quality weights for calculating quality-adjusted life years. In general populations, the measure can be used as quality weights for determining population health expectancy.

Economic Evaluation of Neonatal Intensive Care of Very-Low-Birth-Weight Infants

We evaluated the economic aspects of neonatal intensive care of very-low-birth-weight infants, using outcomes and costs of care before and after the introduction of a regional neonatal-intensive-care program. Neonatal intensive care increased both survival rates and costs. For newborns weighing 1000 to 1499 g, the cost (in 1978 Canadian dollars) was

Stress, social support and depression in single and married mothers.

59,500 per additional survivor,

Screening for Intimate Partner Violence in Health Care Settings: A Randomized Trial

2,900 per life-year gained, and

Integrating Assessment Data from Multiple Informants

3,200 per quality-adjusted life-year gained; intensive care resulted in a net economic gain when figures were undiscounted but a net economic loss when future costs, effects, and earnings were discounted at 5 per cent per annum. For infants weighing 500 to 999 g, the corresponding costs were

One-Year Prevalence of Psychiatric Disorder in Ontarians 15 to 64 Years of Age

102,500 per additional survivor,

Outcome, prognosis, and risk in a longitudinal follow-up study.

9,300 per life-year gained, and

Ontario Child Health Study: Correlates of Disorder

22,400 per quality-adjusted life-year gained; intensive care resulted in a net economic loss. By every measure of economic evaluation, the impact of neonatal intensive care was more favorable among infants weighing 1000 to 1499 g than among those weighing 500 to 999 g. A judgment concerning the relative economic value of neonatal intensive care of very-low-birth-weight infants requires a comparison with other health programs.

Preschoolers at Risk for Attention-Deficit Hyperactivity Disorder and Oppositional Defiant Disorder: Family, Parenting, and Behavioral Correlates

Background: This study examined the effect of stress and social support on the relationship between single-parent status and depression. Method: A secondary data analysis of the 1994–95 National Population Health Survey was conducted. Single and married mothers who participated in the survey were derived from the general sample (N = 2,921). Logistic regression techniques were used to assess the mediating and moderating effects of stress and social support on the relationship between family structure and depression. Results: Bivariate analyses showed that, compared to married mothers, single mothers were more likely to have suffered an episode of depression (12-month prevalence), to report higher levels of chronic stress, more recent life events and a greater number of childhood adversities. Single mothers also reported lower levels of perceived social support, social involvement and frequency of contact with friends and family than married mothers. The results of the multivariate analyses showed that, together, stress and social support account for almost 40% of the relationship between single- parent status and depression. We also found a conditional effect of stress on depression by family structure. Life events were more strongly related to depression in married than in single mothers. Conclusions: A substantial part of the association between single-parent status and depression can be accounted for by differences in exposure to stress and social support.Our results suggest that it is important to examine multiple sources of stress, as exposure to both distal and proximal stressors were higher among single mothers. Limitations and directions for future research are discussed.