William Furlong

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.

Multiattribute Utility Function for a Comprehensive Health Status Classification System Health Utilities Index Mark 2

The Health Utilities Index Mark 2 (HUI:2) is a generic multiattribute, preference-based system for assessing health-related quality of life. Health Utilities Index Mark 2 consists of two components: a seven-attribute health status classification system and a scoring formula. The seven attributes are sensation, mobility, emotion, cognition, self-care, pain, and fertility. A random sample of general population parents were interviewed to determine cardinal preferences for the health states in the system. The health states were defined as lasting for a 60-year lifetime, starting at age 10. Values were measured using visual analogue scaling. Utilities were measured using a standard gamble technique. A scoring formula is provided, based on a multiplicative multiattribute utility function from the responses of 194 subjects. The utility scores are death-anchored (death = 0.0) and form an interval scale. Health Utilities Index Mark 2 and its utility scores can be useful to other researchers in a wide variety of settings who wish to document health status and assign preference scores.

The Health Utilities Index (HUI®): concepts, measurement properties and applications

This is a review of the Health Utilities Index (HUI®) multi-attribute health-status classification systems, and single- and multi-attribute utility scoring systems. HUI refers to both HUI Mark 2 (HUI2) and HUI Mark 3 (HUI3) instruments. The classification systems provide compact but comprehensive frameworks within which to describe health status. The multi-attribute utility functions provide all the information required to calculate single-summary scores of health-related quality of life (HRQL) for each health state defined by the classification systems. The use of HUI in clinical studies for a wide variety of conditions in a large number of countries is illustrated. HUI provides comprehensive, reliable, responsive and valid measures of health status and HRQL for subjects in clinical studies. Utility scores of overall HRQL for patients are also used in cost-utility and cost-effectiveness analyses. Population norm data are available from numerous large general population surveys. The widespread use of HUI facilitates the interpretation of results and permits comparisons of disease and treatment outcomes, and comparisons of long-term sequelae at the local, national and international levels.

The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies

This paper reviews the Health Utilities Index (HUI? systems as means to describe health status and obtain utility scores reflecting health-related quality of life (HRQoL). The HUI Mark 2 (HUI2) and Mark 3 (HUI3) classification and scoring systems are described. The methods used to estimate multiattribute utility functions for HUI2 and HUI3 are reviewed. The use of HUI in clinical studies for a wide variety of conditions in a large number of countries is illustrated. HUI provides a comprehensive description of the health status of subjects in clinical studies. HUI has been shown to be a reliable, responsive and valid measure in a wide variety of clinical studies. Utility scores provide an overall assessment of the HRQoL of patients. Utility scores are also useful in cost-utility analyses and related studies. General population norm data are available. The widespread use of HUI facilitates the interpretation of results and permits comparisons. HUI is a useful tool for assessing health status and HRQoL in clinical studies.

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.

Visual Analog Scales: Do They Have a Role in the Measurement of Preferences for Health States?

Visual analog scales (VASs) have long been used as a method of measuring preferences for health outcomes. They are easy and inexpensive to implement, can be administered quickly, and lend themselves to self-completion. Over time, however, disturbing questions have emerged concerning the validity of the VAS approach. This article reviews briefly the history, theory, practice, problems, and advantages of VASs; presents some suggestions to improve the validity of VASs; and recommends a limited but useful role for VASs in the process of measuring preferences for health states.

Health Utilities Index Mark 3 : Evidence of Construct validity for stroke and arthritis in a population health survey

BACKGROUND The Health Utilities Index Mark 3 (HUI3) is a comprehensive, compact health status classification and health state preference system. The HUI3 system has been included in 4 Canadian population health surveys and numerous clinical trials. OBJECTIVES To evaluate the construct validity of the HUI3 for the measurement of health-related quality of life (HRQL) and attribute-specific morbidity in respondents to the 1990 Ontario Health Survey reported to have arthritis or stroke. The authors assessed (1) whether those with stroke, arthritis, and both conditions had lower HRQL scores than those with neither condition and (2) whether HUI3 detects morbidity in specific health attributes affected by arthritis and stroke. Stroke (but not arthritis) were expected to affect speech and cognition; arthritis (but not stroke) to affect pain; both to affect mobility, dexterity, and emotion; and neither to affect vision and hearing. RESEARCH DESIGN Linear regression models of HRQL and attribute-specific utilities were estimated as a function of 3 indicator variables of health problem (stroke only, arthritis only, both) and variables included to reduce confounding. RESULTS Subjects with stroke, arthritis, and both conditions had substantially lower HRQL than those with neither condition. Stroke subjects had greater morbidity in speech and cognition than arthritis subjects; somewhat surprisingly, pain morbidity was only slightly higher among arthritis subjects; neither condition affected vision or hearing. These associations were robust to various model specifications. CONCLUSIONS The HUI3 system appears valid for measuring health status and HRQL for stroke and arthritis in the context of a noninstitutionalized population health survey.

Economic evaluation of cardiac rehabilitation soon after acute myocardial infarction

Abstract Although there are extensive clinical evaluations of cardiac rehabilitation after acute myocardial infarction (AMI), no full economic evaluation is available. Patients with AMI and mild to moderate anxiety or depression, or both, while still in hospital were randomized to either an 8-week rehabilitation intervention (n = 99) or usual care (n = 102). Comprehensive costs and health-related quality of life, measured with the time trade-off preference score, were obtained in a 12-month trial, and together with survival data derived from published meta-analyses, cost-utility and cost-effectiveness of early cardiac rehabilitation were estimated. The best estimate of the incremental net direct 12-month costs for patients randomized to rehabilitation was

Reliability of the Health Utilities Index—Mark III used in the 1991 cycle 6 Canadian General Social Survey Health Questionnaire

480 (United States, 1991)/ patient. During 1-year follow-up, rehabilitation patients had fewer “other rehabilitation visits” (p

Parental Perspectives of the Health Status and Health-Related Quality of Life of Teen-Aged Children Who Were Extremely Low Birth Weight and Term Controls

This study presents information on the test-retest reliability of the Health Utility Index—Mark III (HUI) system used in cycle 6 of the Canadian General Social Survey (GSS). The HUI system used in this reliability study consists of an eight-attribute health status classification system (HSCS) and a function for generating a summary score of health-related quality of life. To estimate test-retest reliability, a stratified random sample of individuals (n=506) completing GSS telephone interviews during August and September, 1991 were interviewed again 1 month later. Weighting adjustments based on the probability of selection were invoked during the analyses to provide unbiased estimates of testretest reliability for all GSS respondents in the August-September period. The results indicate that the individual questions, attributes and provisional index scores generally provided reliable information on health status in the GSS. The exceptions to this were limitations in speech and dexterity which were reported very infrequently. Kappa estimates of test-retest reliability for individual questions varied from 0.184 to 0.766. For the eight attributes, kappa estimates varied from 0.137 to 0.728. Using the provisional index scores to quantify health overall, a test-retest reliability of 0.767 was obtained (intra-class correlation coefficient).