Incorporating Process Utility into Quality Adjusted Life Years: A Systematic Review of Empirical Studies
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This review aimed to identify published studies that provide an empirical measure of process utility, which can be incorporated into estimates of QALY calculations.
A literature search was conducted in PubMed to identify published studies of process utility. Articles were included if they were written in the English language and reported empirical measures of process utility that could be incorporated into the QALY calculation; those studies reporting utilities that were not anchored on a scale of 0 representing dead and 1 representing full health were excluded from the review.
Fifteen studies published between 1996 and 2012 were included. Studies included respondents from the USA, Australia, Scotland and the UK, Europe and Canada. Eight of the included studies explored process utility associated with treatments; six explored process utility associated with screening procedures or tests; and one was performed in preventative care. A variety of approaches were used to detect and measure process utility: four studies used standard gamble techniques; four studies used time trade-off (TTO); one study used conjoint analysis and one used a combination of conjoint analysis and TTO; one study used SF-36 data; one study used both TTO and EQ-5D; and three studies used wait trade-off techniques. Measures of process utility for different drug delivery methods ranged from 0.02 to 0.27. Utility estimates associated with different dosing strategies ranged from 0.005 to 0.09. Estimates for convenience (able to take on an empty stomach) ranged from 0.001 to 0.028. Estimates of process utility associated with screening and testing procedures ranged from 0.0005 to 0.031. Both of these estimates were obtained for management approaches to cervical cancer screening.
The identification of studies through conventional methods was difficult due to the lack of consistent indexing and terminology across studies; however, the evidence does support the existence of process utility in treatment, screening and preventative care settings. There was considerable variation between estimates. The range of methodological approaches used to identify and measure process utility, coupled with the need for further research into, for example, the application of estimates in economic models, means it is difficult to know whether these differences are a true reflection of the amount of process utility that enters into an individual’s utility function, or whether they are associated with features of the studies’ methodological design. Without further work, and a standardised approach to the methodology for the detection and measurement of process utility, comparisons between estimates are difficult. This literature review supports the existence of process utility and indicates that, despite the need for further research in the area, it could be an important component of an individual’s utility function, which should at least be considered, if not incorporated, into cost-utility analyses.
KeywordsMagnetic Resonance Angiography Extracorporeal Shock Wave Lithotripsy Conjoint Analysis Utility Estimate Process Utility
Victoria K. Brennan and Simon Dixon received no funding for the preparation of this article and have no conflicts of interest that are directly relevant to its content.
- 4.Brouwer WBF, Culyer AJ, van Exel NJA, et al. Welfarism vs. extra-welfarism. J Health Econ. 2008;27(2):325–38.Google Scholar
- 6.Mooney G. Beyond health outcomes: the benefits of health care. Health Care Anal. 1998;6(2):99–1.Google Scholar
- 9.Swan J, Sainfort F. Process utility for imaging in cerebrovascular disease. Acad Radiol. 2003;10(3):266–74.Google Scholar
- 13.Dolan P, Tsuchiya A. Determining the parameters in social welfare function using stated preference data: an application to health. Appl Econ. 2011;43(18):1466–4283.Google Scholar
- 14.Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, et al. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.Google Scholar
- 18.Osborne RH, De Abreu Lourenço R, Dalton A, Houltram J, et al. Quality of life related to oral versus subcutaneous iron chelation: a time trade-off study. Value Health. 2007;10(6):51–6.Google Scholar
- 32.Stouthard MEA, Essink-Bot ML, Bonsel GJ, Barendregt JJ, Kramer PG, van de Water HPA, Gunning-Schepers LJ, van der Maas PJ. Disability weights for diseases in the Netherlands. Rotterdam: Erasmus University; 1997.Google Scholar
- 34.Gold MR, Siegel JE, Russell LB, et al., editors. Cost-effectiveness in health and medicine. Oxford: Oxford University Press; 1996.Google Scholar
- 35.Brazier J, Akehurst R, Brennan A, Dolan P, Claxton K, McCabe C, Sculpher M, Tsuchyia A. Should patients have a greater role in valuing health states? Appl Health Econ Health Policy. 2005;4(4):201–8.Google Scholar
- 36.Gafni A, Zylak CJ. Ionic versus non-ionic contrast media: a burden or a bargain? Can Med Assoc J. 1990;143(6):475–8.Google Scholar
- 37.Brazier JE, Rowen D. NICE DSU Technical Support Document 11: Alternatives to EQ-5D for generating health state utility values. 2011. http://www.nicedsu.org.uk. Accessed 18 Sept 2012.
- 39.Yang Y, Brazier J, Tsuchiya. The effect of adding a ‘sleep’ dimension to EQ-5D. In: Health Economists’ Group meeting. January 2008.Google Scholar
- 40.Brazier J, Rowen D, Tsuchiya A, Yang Y, Young T. What a pain: adding a generic dimension to a condition-specific preference-based measure. In: HESG Abstract. 2010.Google Scholar
- 41.Steine S, Finset A, Laerum E. A new, brief questionnaire (PEQ) developed in primary health care for measuring patients’ experience of interaction, emotion and consultation outcome. Family Practice. 2001;18:410–8.Google Scholar
- 42.Baron J. Biases in the quantitative measurement of values for public decisions. Psychol Bull. 1997;122:72–88.Google Scholar
- 43.Dolan P, Kahneman D. Interpretations of utility and their implications for the valuation of health. Econ J. 2008;118(525):215–34.Google Scholar