Article2003

A view from the bridge: agreement between the SF‐6D utility algorithm and the Health Utilities Index

Bernie J. OʼBrien · Marian A. Spath · Gordon Blackhouse · Johan Louis Severens · Paul Dorian · John Edward Brazier

95 citations0/0 files storedHealth Economics

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Health Systems, Economic Evaluations, Quality of Life Economic and Environmental Valuation Health Education and Validation

Abstract

BACKGROUND: The SF-6D is a new health state classification and utility scoring system based on 6 dimensions ('6D') of the Short Form 36, and permits a "bridging" transformation between SF-36 responses and utilities. The Health Utilities Index, mark 3 (HUI3) is a valid and reliable multi-attribute health utility scale that is widely used. We assessed within-subject agreement between SF-6D utilities and those from HUI3. METHODS: Patients at increased risk of sudden cardiac death and participating in a randomized trial of implantable defibrillator therapy completed both instruments at baseline. Score distributions were inspected by scatterplot and histogram and mean score differences compared by paired t-test. Pearson correlation was computed between instrument scores and also between dimension scores within instruments. Between-instrument agreement was by intra-class correlation coefficient (ICC). RESULTS: SF-6D and HUI3 forms were available from 246 patients. Mean scores for HUI3 and SF-6D were 0.61 (95% CI 0.60-0.63) and 0.58 (95% CI 0.54-0.62) respectively; a difference of 0.03 (p<0.03). Score intervals for HUI3 and SF-6D were (-0.21 to 1.0) and (0.30-0.95). Correlation between the instrument scores was 0.58 (95% CI 0.48-0.68) and agreement by ICC was 0.42 (95% CI 0.31-0.52). Correlations between dimensions of SF-6D were higher than for HUI3. CONCLUSIONS: Our study casts doubt on the whether utilities and QALYs estimated via SF-6D are comparable with those from HUI3. Utility differences may be due to differences in underlying concepts of health being measured, or different measurement approaches, or both. No gold standard exists for utility measurement and the SF-6D is a valuable addition that permits SF-36 data to be transformed into utilities to estimate QALYs. The challenge is developing a better understanding as to why these classification-based utility instruments differ so markedly in their distributions and point estimates of derived utilities.

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References

1992The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.1992The MOS 36-ltem Short-Form Health Survey (SF-36)2005Methods for the Economic Evaluation of Health Care Programmes 2003SF-36 health survey: Manual and interpretation guide 1994Decisions with Multiple Objectives: Preferences and Value Tradeoffs.1993Decisions with Multiple Objectives 2002The estimation of a preference-based measure of health from the SF-36 1986Measurement of health state utilities for economic appraisal

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