Advertisement

Quality of Life Research

, Volume 5, Issue 6, pp 521–531 | Cite as

Health state valuations from the general public using the Visual Analogue Scale

  • C. Gudex
  • P. Dolan
  • P. Kind
  • A. Williams
Research Papers

Abstract

In the clinical and economic evaluation of health care, the value of benefit gained should be determined from a public perspective. The objective of this study was to establish relative valuations attached to different health states to form the basis for a ‘social tariff’ for use in quantifying patient benefit from health care. Three thousand three hundred and ninety-five interviews were conducted with a representative sample of the adult British population. Using the EuroQol health state classification and a visual analogue scale (VAS), each respondent valued 15 health states producing, in total, direct valuations for 45 states. Two hundred and twenty-one re-interviews were conducted approximately 10 weeks later. A near complete, and logically consistent, VAS data set was generated with good test-retest reliability (mean ICC=0.78). Both social class and education had a significant effect, where higher median valuations were given by respondents in social classes III–V and by those with intermediate or no educational qualifications. These effects were particularly noticeable for more severe states. The use of such valuations in a social tariff raises important issues regarding the use of the VAS method itself to elicit valuations for hypothetical health states, the production of separate tariffs according to social class and/or education and the appropriate measure of central tendency.

Key words

EuroQol health status measurement social preferences visual analogue scale 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Patrick DL, Erikson P. Health status and health policy: quality of life in health care evaluation and resource allocation. New York: Oxford University Press, 1992.Google Scholar
  2. 2.
    Torrance GW. Measurement of health state utilities for economic appraisal. J Health Economics 1986; 5: 1–30.Google Scholar
  3. 3.
    Hornberger JC, Redelmeier DA, Petersen J. Variability among methods to assess patients' well-being and consequent effect on a cost-effectiveness analysis. J Clin Epidemiol 1992; 45: 505–512.Google Scholar
  4. 4.
    Read JL, Quinn RJ, Bewick DM, Fineberg HV, Weinstein ML. Preferences for health outcomes: comparison of assessment methods. Med Decis Making 1984; 4: 315–329.Google Scholar
  5. 5.
    Daly E, Gray A, Barlow D, McPherson K, Roche M, Vessey M. Measuring the impact of menopausal symptoms on quality of life. BMJ 1993; 307: 836–840.Google Scholar
  6. 6.
    Nord E. The validity of a visual analogue scale in determining social utility weights for health states. Int J Health Planning Management 1991; 6: 234–242.Google Scholar
  7. 7.
    Fernandez E, Turk DC. Sensory and affective components of pain: separation and synthesis. Psychol Bull 1992; 112: 205–217.Google Scholar
  8. 8.
    Fahndrich E, Linden M. Zur Reliabilitat und Validitat der Stimmungsmessung mit der Visuellen Analog-Skala (VAS). Pharmacopsychiat 1982; 15: 90–94.Google Scholar
  9. 9.
    Kaplan RM, Ernst JA. Do category rating scales produce biased preference weights for a health index? Med Care 1983; 21: 193–207.Google Scholar
  10. 10.
    Kaplan RM, Bush JW, Berry CC. Category rating versus magnitude estimation for measuring levels of well-being. Med Care 1979; 17: 501–521.Google Scholar
  11. 11.
    Torrance GW, Boyle HH, Horwood SP. Application of multi-attribute utility theory to measure social preferences for health states. Operations Res 1982; 30: 1043–1069.Google Scholar
  12. 12.
    Wolfson AD, Sinclair AJ, Bombardier C, McGeer A. Preference measurements for functional status in stroke patients: interrater and intertechnique comparisons. In: Kane RL, Kane RA, eds. Values and Long Term Care. Lexington, MA: Lexington Books, 1982: 191–213.Google Scholar
  13. 13.
    O'Boyle CA, McGee H, Hickey A, O'Maller K, Joyce CRB. Individual quality of life in patients undergoing hip replacement. Lancet 1992; 339: 1088–1091.Google Scholar
  14. 14.
    Sculpher MJ, Bryan S, Dwyer N, Hutton J, Stirrat GM. An economic evaluation of transcervical endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia. Br J Obstet Gynaecol 1993; 100: 244–252.Google Scholar
  15. 15.
    Llewellyn-Thomas HA, Sutherland HJ, Thiel EC. Do patients' evaluations of a future health state change when they actually enter that state? Med Care 1993; 31: 1002–1012.Google Scholar
  16. 16.
    EuroQol Group. EuroQol: A new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208.Google Scholar
  17. 17.
    Humphreys W, Evans F, Williams T. Quality of life: Is it a practical tool in patients with vascular disease? J Cardiovascular Pharmacol 1994; 23(Suppl 3): S34–S36.Google Scholar
  18. 18.
    Essink-Bot ML, Bonsel G, van der Maas PJ. Valuation of health states by the general public: feasibility of a standardised measurement procedure. Soc Sci Med 1990; 31: 1201–1206.Google Scholar
  19. 19.
    Brazier J, Jones N, Kind P. Testing the validity of the EuroQol and comparing it with the SF-36 health survey questionnaire. Qual Life Res 1993; 2: 169–180.Google Scholar
  20. 20.
    Nord E. EuroQol: health-related quality of life measurement: valuations of health states by the general public in Norway. Health Policy 1991; 18: 25–36.Google Scholar
  21. 21.
    Brooks RG, Jendteg S, Lindgren B, Persson U, Bjork S. EuroQol. health-related quality of life measurement: results of a Swedish questionnaire exercise. Health Policy 1991; 18: 37–48.Google Scholar
  22. 22.
    Dolan P, Gudex C, Kind P, Williams A. Valuing health states: a comparison of methods. (submitted for publication)Google Scholar
  23. 23.
    Stevens SS. Issues in psychophysical measurement. Psychol Rev 1971; 78: 426–450.Google Scholar
  24. 24.
    Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. Oxford: Oxford Medical Publications, 1994.Google Scholar
  25. 25.
    OPCS, General Household Survey. Series GHS No. 23, London: HMSO, 1992.Google Scholar
  26. 26.
    OPCS. Key population and vital statistics. Series VS No. 17, London: HMSO, 1990.Google Scholar
  27. 27.
    Churchill DN, Torrance GW, Taylor CC, et al. Measurement of quality of life in end-stage renal disease: the time trade-off approach. Clin Invest Med 1987; 10: 14–20.Google Scholar
  28. 28.
    Ganz PA, Haskell CM, Figlin RA, la Soto N, Siau J. Estimating the quality of life in a clinical trial of patients with metastatic lung cancer using the Karnofsky Performance Status and the Functional Living Index — Cancer. Cancer 1988; 61: 849–856.Google Scholar
  29. 29.
    Wiklund I, Swedberg K. Some methodological problems in analysing quality of life data in severe congestive heart failure patients. J Clin Res Pharmacoepidemiol 1991; 5: 265–273.Google Scholar
  30. 30.
    van Dalen H, Williams A, Gudex C. Lay people's evaluations of health: are there variations between different subgroups? J Epidemiol Comm Health 1994; 48: 248–253.Google Scholar
  31. 31.
    Blaxter M. Lay concepts of health and survey measures. Survey Methods Newsletter Winter 1988/1989.Google Scholar
  32. 32.
    Buckingham K, Drummond N. A theoretical and empirical classification of health valuation techniques. Paper to Health Economists' Study Group meeting, Strathclyde, 1993.Google Scholar
  33. 33.
    O'Connor A, Boyd N, Till J. Influence of elicitation technique, position order and test-retest error on preferences for alternative cancer drug therapy. Nursing Research: Science for Quality Care Proc 10th National Nursing Research Conference. Toronto: University of Toronto, 1985.Google Scholar
  34. 34.
    Rosser R, Kind P. A scale of valuations of states of illness: is there a social consensus? Int J Epidemiol 1978; 7: 347–358.Google Scholar
  35. 35.
    Kaplan RM, Bush JW, Berry CC. The reliability, stability and generalizability of a health status index. Proc Social Stat Section. American Statistical Association, 1978; 704–709.Google Scholar
  36. 36.
    Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chronic Dis 1978; 31: 697–704.Google Scholar
  37. 37.
    Carter WB, Bobbitt RA, Bergner M, Gilson B. Validation of an interval scaling: the Sickness Impact profile. Health Serv Res 1976; Winter: 516–528.Google Scholar
  38. 38.
    Patrick DL, Bush JW, Chen MM. Methods for measuring levels of well-being for a health status index. Health Serv Res 1973; 8: 228–245.Google Scholar
  39. 39.
    Llewellyn-Thomas H, Sutherland HJ, Tibshirani R, Ciampi A, Till J, Boyd NF. Methodologic issues in obtaining values for health states. Med Care 1984; 22: 543–552.Google Scholar
  40. 40.
    Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA. Measuring preferences for health states worse than death. Med Decis Making 1994; 14: 9–18.Google Scholar
  41. 41.
    Anderson NH. How functional measurement can yield validated interval scales of mental quantities. J Appl Psychol 1976; 61: 677–692.Google Scholar
  42. 42.
    Kaplan RM, Bush JW, Berry CC. Health status: types of validity and the index of well-being. Health Serv Res 1976; Winter: 478–507.Google Scholar
  43. 43.
    Parducci A. Contextual effects: a range-frequency analysis. In: Carterette EC, Friedman MP, eds. Handbook of Perception: II. Psychophysical Judgement and Measurement London: Academic Press, 1974.Google Scholar
  44. 44.
    Torgerson WS. Theory and Methods of Scaling. New York: John Wiley & Sons, 1958.Google Scholar
  45. 45.
    Sutherland HJ, Llewellyn-Thomas H, Boyd NF, Till JE. Attitudes towards quality of survival: the concept of maximal endurable time. Med Decis Making 1982; 2: 299–309.Google Scholar
  46. 46.
    Gudex C, Dolan P. Valuing health states: the effect of duration. (submitted for publication)Google Scholar
  47. 47.
    Dolan P, Gudex C. Time preference, duration and health state valuations Health Economics (in press)Google Scholar

Copyright information

© Rapid Science Publishers 1996

Authors and Affiliations

  • C. Gudex
    • 1
  • P. Dolan
    • 2
  • P. Kind
    • 1
  • A. Williams
    • 1
  1. 1.Centre for Health EconomicsUniversity of YorkYorkUK
  2. 2.Department of EconomicsUniversity of NewcastleCallaghanAustralia

Personalised recommendations