What do utilities measure?

Abstract

Quality of life is at once a simple yet very complex paradigm, with philosophers, sociologists, psychologists, economists, theologians, clinicians, and lay persons all having different conceptualizations.1-4 Health-related quality of life (HRQOL) can be thought of as 1 aspect or domain of quality of life, and it too has its own conceptualizations. There are numerous HRQOL instruments in existence,5 emanating from 2 fundamentally different approaches: health status measurement and value/preference/ utility assessment. (Value/preference/utility measures are sometimes referred to synonymously as HRQOL measures, as are health status measures, but here I prefer to use HRQOL in the more general sense, to include both health status and value/preference/ utility measures.) In general, health status measures describe a person's functioning in 1 or more domains (eg, physical functioning and mental health). Currently, one of the most commonly used health status instruments is the Medical Outcomes Study Short Form-36,6 a 36-item measure that encompasses 8 domains: physical functioning, social functioning, mental health, role limitations due to physical problems, role limitations due to emotional problems, vitality (energy and fatigue), pain, and general health perceptions, each of which is scored separately from 0 (worst) to 100 (best) Value/preference/utility measures, in contrast, assess the value or desirability of a state of health against an external metric.7-9 Here, the most common instruments are the standard reference gamble, time tradeoff, and rating scale.9-12 The standard gamble, the most orthodox utility measure, determines the risk of (usually) death that one would be willing to take to improve a state of health. The time tradeoff technique asks how many months or years of life one would be willing

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