The measurement and valuation of utility based quality of life: recommendations from a review of the literature

The Commonwealth Department of Health and Family Services is considering options for the update of its guidelines for the preparation of economic analyses which must accompany submissions to the Pharmaceutical Benefits Advisory Committee (PBAC) for the inclusion of new pharmaceuticals on the Pharmaceutical Benefits Schedule (PBS). As part of this process, the Health Economics Unit of Monash University was commissioned to conduct a review of utility-based quality of life measures with a view to determining the feasibility and/or desirability of developing criteria to assess the quality of utility-based quality of life measures. Such criteria were deemed feasible and desirable and the Health Economics Unit specified a set of guidelines for the measurement and valuation of utility weights, based on theoretical argument and empirical findings drawn from the literature. This paper reports the recommended guidelines arising from the literature review. In-depth discussion of issues surrounding the utility-based quality of life literature, as well as critical reviews of the quality adjusted life year (QALY) and multi-attribute utility (MAU) literatures are given in several companion CHPE working papers. Our overall recommendations are as follows: (i) Ideally, ‘core’ utility measurement should be carried out with an MAU instrument. Holistic measurement should only be used as a supplement. (ii) It is recognised that, especially in a short run, research teams may be unable to meet this requirement and, that well-conducted holistic measurement is clearly better than no utility measurement at all. (iii) Where possible, holistic measurement should meet the requirements detailed in the guidelines and the persuasiveness of the utility evidence should be, in large part, a function of the adoption of the recommended procedures. (iv) The meaning of cost utility ratios calculated with idiosyncratic methods is difficult to interpret and should be discounted. (v) The use of an MAU instrument imposes a particular set of characteristics upon the utility measurement. Optional measurement additional to or, in exceptional circumstance, replacing core measurement should therefore adopt the same characteristics. Any optional or supplementary measurement must be carried out in such a way that the information is comparable with core information from other studies.

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