Utility Scores for Comorbid Conditions: Methodological Issues and Advances
Utility scores quantify health-related quality of life (HRQOL) along a continuum that typically ranges from 0.0 (dead) to 1.0 (full health), and are essential in developing summary measures of population health (SMPH), as well as performing cost-effec
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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
2 2.1 2.2 2.3
Comorbidity: an Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 Definition of Comorbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 Co-Morbidity is a Ubiquitous and High-Impact Phenomenon . . . . . . . . . . . . . . . . . . . . . 362 Comorbidity is a Challenge for Health Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362
3 3.1 3.2 3.3 3.4 3.5
Approaches to Deriving Utility Scores for Comorbidities . . . . . . . . . . . . . . . . . . . . . . . . . 364 Direct Utility Elicitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 Indirect Utility Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 Combining Single–Condition Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 Testing Mathematical Models for Combining Single-Condition Utility Scores . . . . . 373 A Hybrid Mathematical Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
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Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 Summary Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
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Springer Science+Business Media LLC 2010 (USA)
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Utility Scores for Comorbid Conditions: Methodological Issues and Advances
Abstract: > Utility scores quantify > health-related quality of life (HRQOL) along a continuum that typically ranges from 0.0 (dead) to 1.0 (full health), and are essential in developing > summary measures of population health (SMPH), as well as performing > cost-effectiveness analysis (CEA) of different treatments and intervention strategies. A key methodological issue is that traditionally, utility scores have been developed primarily for single health conditions, even though comorbidities are common in both general and patient populations. Inaccuracies in health measurement are likely to occur when > comorbidity is ignored in the estimation of utility scores. In this chapter, methodological issues and advances with regard to deriving utility scores for comorbid health conditions are reviewed. Direct utility elicitation protocols such as the standard gamble (SG) or time trade-off (TTO) are the most theoretically desirable approaches, but are cognitive
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