Constructing Indirect Utility Models: Some Observations on the Principles and Practice of Mapping to Obtain Health State Utilities
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The construction of mapping models is an increasingly popular mechanism for obtaining health state utility data to inform economic evaluations in health care. There is great variation in the sophistication of the methods utilized but to date very little discussion of the appropriate theoretical framework to guide the design and evaluation of these models. In this paper, we argue that recognizing mapping models as a form of indirect health state valuation allows the use of the framework described by Dolan for the measurement of social preferences over health. Using this framework, we identify substantial concerns with the method for valuing health states that is implicit in indirect utility models (IUMs), the conflation of two sets of respondents’ values in such models, and the lack of a structured and statistically reasonable approach to choosing which states to value and how many observations per state to require in the estimation dataset. We also identify additional statistical challenges associated with clustering and censoring in the datasets for IUMs, additional to those attributable to the descriptive systems, and a potentially significant problem with the systematic understatement of uncertainty in predictions from IUMs. Whilst recognizing that IUMs appear to meet the needs of reimbursement organizations that use quality-adjusted life years in their appraisal processes, we argue that current proposed quality standards are inadequate and that IUMs are neither robust nor appropriate mechanisms for estimating utilities for use in cost-effectiveness analyses.
- 1.Collinson FJ, Gregory, W. McCabe, C et al. The STAR TRIAL protocol: a randomized multi-stage II/III study of sunitinib comparing temporary cessation with allowing continuation, at the time of maximal radiological response, in the first line treatment of local advanced/metastatic renal cancer. BMC Cancer. 2012;598:1–11.Google Scholar
- 3.Brazier J, Ratcliffe J, Salomon JA, Tsuchiya A. Measuring and valuing health benefits for economic evaluation. Oxford: Oxford University Press; 2007.Google Scholar
- 5.European Organisation for Research and Treatment of Cancer. EORTC QLQ-C30. http://groups.eortc.be/qol/eortc-qlq-c30. Accessed 19 Jun 2013.
- 6.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.PubMedCrossRefGoogle Scholar
- 7.Longworth L, Rowan, D. NICE DSU technical support document 10: the use of mapping methods to estimate health state utility values (2011). http://www.nicedsu.org.uk/TSD%2010%20mapping%20FINAL.pdf. Accessed 19 Jun 2013.
- 10.McCabe C, Stevens K, Roberts J, Brazier JE. Health state values for the HUI2 descriptive system: results from a UK survey. Health Econ. 2005;14:231–44.Google Scholar
- 11.Xie F, Gaebel K, Perampaladas K, Doble B, Pullenayegum E. Comparing EQ-5D valuation studies: a systematic review and methodological checklist. Med Decis Mak. Online First March 22, 2013. p. 1–323.Google Scholar
- 13.Dolan P. The measurement of health related quality of life for use in resource allocation decisions in health care. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics. Amsterdam: Elsevier Science BV; 2000.Google Scholar
- 14.National Institute for Health and Clinical Excellence. Guide to the methods of health technology appraisal (2008). http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf. Accessed 19 Jun 2013.
- 15.Brazier J, Akerhurst R, Brennan A, et al. Should patients have a greater role in valuing health states? Appl Health Econ Health Policy. 2005;4(4):201-8.Google Scholar
- 16.Gold MR, Segel JE, Russell LB, Weinsten MC. Cost effectiveness in health and medicine. New York: Oxford University Press, 1996.Google Scholar
- 17.Brazier JE, Longworth L. NICE DSU technical document 8: an introduction to the measurement and valuation of health for NICE submissions (2011). http://www.nicedsu.org.uk/TSD8%20Introduction%20to%20MVH_final.pdf. Accessed 19 Jun 2013.
- 20.Hernández Alava M, Wailoo A, Ara R. Tails from the Peak District: adjusted censored mixture models of EQ-5D health state utility values (2010). http://eprints.whiterose.ac.uk/11074/1/HEDS_DP_10-08.pdf. Accessed 19 Jun 2013.
- 22.Kharroubi SA, McCabe C. Modelling HUI 2 health state preference data using a nonparametric Bayesian method. Med Decis Mak. 2008;28:875–87.Google Scholar
- 23.National Institute for Health and Clinical Excellence. Patient access schemes and the NICE Patient Access Liaison Unit (2013). http://www.nice.org.uk/aboutnice/howwework/paslu/patientaccessschemesliaisonunit.jsp. Accessed 13 Feb 2013.
- 24.Claxton K, Palmer S, Longworth L, Bojke L, Griffin S, McKenna C, Soares M, Spackman DE, Youn J. Informing a decision framework for when NICE should recommend the use of health technologies only in the context of an appropriately designed programme of evidence development. Health Technol Assess. 2012;16.Google Scholar