Abstract
Background: Quality of life is measured as utilities for cost-effectiveness analyses. Objective: To test the adequacy of three common utility elicitation methods for individuals with Human Immunodeficiency Virus (HIV) disease. Measurements: HIV-positive participants (n = 75) rated three standardized health states (symptomatic HIV infection, minor AIDS defining illness, and major AIDS defining illness) with two utility elicitation methods (Standard Gamble [SG], and Time Trade-off [TTO]) and one value method (Visual Analog [VA]). Participants also rated their own health with one utility method (Health Utilities Index [HUI]) and one conventional quality of life method (Medical Outcomes Study–HIV Health Survey [MOS-HIV]). Results: For all states, SG and TTO scores ranged from near 0.00 (equivalent to death) to 1.00 (best possible quality of life). Mean scores for symptomatic HIV were similar with the SG (0.80) and TTO (0.81) but higher than with the VA (0.70). Similar results were observed for minor AIDS defining illnesses (0.65, 0.65, 0.46 respectively) and major AIDS defining illnesses (0.42, 0.44, 0.25 respectively). Discrepant SG and TTO scores were observed in many individuals and were not explained by demographic characteristics. As expected, HUI scores of an individual's own health were related to the disease state. Four of ten MOS-HIV subscales (overall health, physical functioning, role functioning, and pain) were also related to disease state. HUI scores were correlated with the MOS-HIV score for overall health and for all MOS-HIV subscales except health transition. Conclusions: Mean utility scores for HIV-related health states elicited by the Standard Gamble and Time Trade-off were similar but a large degree of individual variation persists. Economic methods provide imprecise estimates of the quality of life associated with HIV infection.
Similar content being viewed by others
References
Gold MR, Se igel JE, Russell LB, Weinstein MC (eds). Cost-e.ectiveness in health and medicine. New York: Oxford University Press, 1996.
Detsky AS, Naglie IG. A clinician's guide to cost-effectiveness analysis. Ann Int Med 1990;113: 147–154.
Rose DN, Sacks HS. Cost-e.ectiveness of cytomegalovirus (CMV) disease prevention in patients with AIDS: oral ganciclovir and CMV polymerase chain reaction testing. AIDS 1997; 11: 883–887.
Gulick RM. Current antiretroviral therapy: an overview. Qual Life Res 1997; 6: 471–474.
Wu AW, Lamping DL. Assessment of quality of life in HIV disease. AIDS 1994; 8: S349-S359.
Shumaker SA, Ellis S, Naughton M. Assessing healthrelated quality of life in HIV disease: key measurement issues. Qual Life Res 1997; 6: 475–480.
Tsevat J, Dawson NV, Matchar DB. Assessing quality of life and preferences in the seriously ill using utility theory. J Clin Epidemiol 1990; 43(Suppl): 73S-77S.
Torrance GW. Utility approach to measuring healthrelated quality of life. J Chron Dis 1987; 6: 593–600.
Torrance GW, Feeny D. Utilities and quality-adjusted life years. Int J Tech Assess Health Care 1989; 5: 559–575.
Froberg DG, Kane RL. Methodology for measuring health-state preferences I: measurement strategies. J Clin Epidemiol 1989; 42: 345–354.
Froberg DG, Kane RL. Methodology for measuring health-state preferences II: scaling methods. J Clin Epidemiol 1989; 42: 459–471.
Nord E. Methods for quality adjustment of life years. Soc Sci Med 1992; 34: 559–569.
Lamping DL. Methods for measuring outcomes to evaluate interventions to improve health-related quality of life in HIV infection. Psychology and Health. 1994; 9: 31–49.
Copfer AE, Ampel NM, Hughes TE, et al. The use of two measures of health-related quality of life in HIVinfected individuals: a cross-sectional comparison. Qual Life Res 1996; 5: 281–286.
Tsevat J, Solzan JG, Kuntz KM, Ragland J, Currier JC, Sell RL, Weinstein MC. Health values of patients infected with Human Immunodeficiency Virus: relationship to mental health and physical functioning. Med Care 1996; 34: 44–57.
Revicki DA, Wu AW, Murray MI. Change in clinical status, health status, and health utility outcomes in HIV-infected patients. Med Care 1995; 33(Suppl): AS173-AS182.
Owens DK, Cardinalli AB, Nease RF. Physicians assessments of the utility of health states associated with Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) infection. Qual Life Res 1997; 6: 77–86.
Holtgrave DR, Pinkerton SD. Updates of cost of illness and quality of life estimates for use in economic evaluations of HIV prevention programs. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16: 54–62.
Bult JR, Hunink MGM, Tsevat J, Weinstein MC. Heterogeneity in the relationship between the Time Tradeo. and Short Form-36 for HIV-infected and primary care patients. Med Care 1998; 36: 523–532.
Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986; 5: 1–30.
Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, validity and usefulness of the Medical Outcomes Study HIV health survey (MOSHIV). Qual Life Res 1997; 6: 481–493.
Mocroft AJ, Johnson MA, Sabin CA, et al. Staging system for clinical AIDS patients. Lancet 1995; 346: 12–27.
Turner BJ, Markson LE, McKee L, Houchens R, Fanning T. The AIDS-defining diagnosis and subsequent complications: a survival-based severity index. J Acquir Immune Defic Syndr 1991; 4: 1059–1071.
Redelmeier DA, Detsky AS. A clinician's guide to utility analysis. Primary Care: Clinics in Office Practice 1995; 14: 82–90.
Bayoumi AM, Redelmeier DA. Preventing Mycobacterium avium complex in patients who are using protease inhibitors: a cost-e.ectiveness analysis. AIDS 1998; 12: 1503–1512.
Torrance GW. Social preferences for health states: an empirical evaluation of three measurement techniques. Socio-Econ Planning Sci 1976; 10: 129–136.
Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science 1981; 211: 453–458.
Froberg DG, Kane RL. Methodology for measuring health-state preferences III: population and context e.ects. J Clin Epidemiol 1989; 42: 585–592.
Hershey JC, Kunreuther HC, Schoemaker PJH. Sources of bias in assessment procedures for utility functions. Management Sci.1982; 28: 936–955.
McNeil BJ, Pauker SG, Sox HC, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med 1982; 306: 1259–1262.
Gerard K, Dobson M, Hall J. Framing and labelling e.ects in health descriptions: quality adjusted life years for treatment of breast cancer. J Clin Epidemiol 1993; 46: 77–84.
Torrance GW, Furlong W, Feeny D, Boyle M. Multiattribute preference functions: Health utilities index. PharmacoEconomics 1995; 7: 503–520.
Feeny D, Furlong W, Boyle M, Torrance GW. Multi-attribute health status classification systems: health utilities index. PharmacoEconomics 1995; 7: 490–502.
Wu AW, Rubin HR, Mathews WC, et al. A health status questionnaire using 30 items from the Medial Outcomes Study: preliminary validation in persons with early HIV infection. Med Care 1991; 29: 786–798.
Torrance GW, Feeny DH, Furlong WJ, Barr RD, Zhang Y, Wang Q. Multiattribute utility function for a comprehensive health status classification system. Health Utilities Index Mark 2. Med Care 1996; 34: 702–722.
Wu AW, Mathews WC, Brysk LT, et al. Quality of life in a placebo-controlled trial of zidovudine in patients with AIDS and AIDS-related complex. J Acquir Immune Defic Syndr 1990; 3: 683–690.
Fleiss JL. tStatistical methods for rates and proportions. 2nd ed. New York: Wiley, 1981.
Gold MR, Patrick DL, Torrance GW, et al. Identifying and valuing health outcomes. In: Gold MR, Seigel JE, Russell LB, Weinstein MC (eds). Cost-e.ectiveness in health and medicine. New York: Oxford University Press, 1996: 82–134.
Cunningham WE, Bozzette SA, Hays RD, Kanouse DE, Shapiro MF. Comparison of health-related quality of life in clinical trial and nonclincal trial human-immunodeficiency virus-infected cohorts. Med Care 1995; 33: AS15-AS25.
Llewellyn-Thomas H, Sutherland HJ, Tibshirani R, Ciampi A, Till JE, Boyd NF. Describing health states: methodologic issues in obtaining values for health states. Med Care 1984; 22: 542–552.
Read JL, Quinn RJ, Berwick DM, Fineberg HV, Weinstein MC. Preferences for health outcomes: Comparison of assessment methods. Med Decis Making 1991; 14: 82–90.
Dolan P, Gudex C, Kind P, Williams A. Valuing health states: a comparison of methods. J Health Econ 1996; 15: 209–231.
Stiggelbout AM, Kiebert GM, Kievitt J, Leer JWH, Stoter G, DeHaes JCJM. Utility assessment in cancer patients: adjustment of time tradeo. scores for the utility of life years and comparison with standard gamble scores. Med Decis Making 1994; 14: 82–90.
Hornberger JC, Redelmeier DA, Petersen J. Variability among methods to assess patients' well-being and consequent e.ect on a cost-e.ectiveness analysis. J Clin Epidemiol 1992; 45: 505–512.
Bombardier C, Wolfson AD, Sinclair AJ, McGeer A. Comparison of three preference measurement methodologies in the evaluation of a function status index. In: Deber RB, Thompson CG (eds). Choices in health care: decision-making and evaluation of e.ectiveness. Toronto; 1982: 145–159.
Fowler FJ, Cleary PD, Massagli MP, Weissman J, Epstein A. The role of reluctance to give up life in the measurement of values of health states. Med Decis Making 1995; 15: 95–200.
Owens DK, Nease RF. Occupational exposure to human immunodeficiency virus and hepatitis B virus: a comparative analysis of risk. Am J Med 1992; 92: 503–512.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bayoumi, A.M., Redelmeier, D.A. Economic methods for measuring the quality of life associated with HIV infection. Qual Life Res 8, 471–480 (1999). https://doi.org/10.1023/A:1008969512182
Issue Date:
DOI: https://doi.org/10.1023/A:1008969512182