Jeff Richardson () (Centre for Health Economics, Monash University) Stuart Peacock (British Columbia Cancer Agency, Vancouver, British Columbia, Canada) Angelo Iezzi () (Centre for Health Economics, Monash University) Neil Day (Centre for Program Evaluation, University of Melbourne) Graeme Hawthorne (Department of Psychiatry, University of Melbourne)
Abstract
MAU instruments seek to measure the ‘utility’ of health states in a way suitable for use in economic evaluation studies and, in particular, cost utility analysis (CUA). The Assessment of Quality of Life, Mark 2 (AQoL 2) project was undertaken specifically to increase the sensitivity of measurement in the region of full health, where most other instruments, including the earlier AQoL 1 instrument are relatively insensitive. In sum, the AQoL 2 instrument estimates utility using a three stage procedure. Items are (i) weighted and combined using a multiplicative model to obtain dimension scores; (ii) these are similarly weighted and combined to obtain an initial AQoL score; (iii) this is then transformed econometrically to produce the final estimate of a health state utility. As with AQoL 1 the research program also sought to experiment with new methods for achieving this. AQoL 1 was the first instrument to use a multi level descriptive system with five dimensions of health separately modelled and then combined. After experimentation it incorporated a new way of modelling the utility of health states worse than death. AQoL 2 adopted this same multi level structure It was developed in 2 stages. The first used a series of confirmatory factor analysis using Lisrel, to construct dimension models. The second was a confirmatory factor (SEM) analysis of the overall AQoL which combined all of the dimensions. Utility scores were modelled in three stages. Time trade-off (TTO) importance weights were first combined into dimensions and to the dimensions into a single score using multiplicative (non stochastic) models (as with AQoL 1). However these were subsequently adjusted in a third stage econometric ‘correction’ based upon independently collected multi attribute – TTO – scores.
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