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A measurement and validation of health: a chronicle

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  • Alan Williams

Abstract

Objective: to measure a health-related quality of life in a way that reflects salient features of health as perceived by a representative sample of the adult population of the UK. Choosing a descriptive system: with data from a survey of 600 people in the West Midlands, we appraised 6 existing ways of measuring health-related quality of life and chose EuroQol. Choosing a valuation method: Phase I: two direct methods (Time Trade-Off [TTO]) and Magnitude Estimation [ME]) and two indirect ones (Pairwise Comparison and Category Rating [CR]) were studied. A survey of almost 300 subjects in the City of York led us to discard ME in favour of TTO. Choosing a valuation method: Phase II: in the early stages of Phase II we tested TTO against SG on a within-subject basis. Our findings were that there was little to choose between them, but TTO had more complex data and more consistent valuations at individual level. The main survey: 1993 pilots: the first pilot indicated that respondents could not handle more than 15 states. The second was a “full dress rehearsal” for the main survey. The main survey: design and execution: each interview consisted of: self-reported health; ranking of states; VAS rating of states; TTO rating of states; personal data. The main fieldwork was conducted in late 1993. The main survey: results: 3395 interviews were achieved, a response rate of 64%, The data on self-reported health showed that problems generally increase with age, and within every age group, by social class too. With the VAS, median scores were all positive (i.e. every date was rated as better than being dead by a majority of respondents). Higher median scores were given by the lower social classes and by the less educated, meaning that they do not think that poorer health states are as bad as the others do. With the TTO far more states were rated worse than being dead. There were some differences between men and women, and also according to marital status and employment status, but the most marked effect was age. AT retest all 3 methods proved very reliable at both group and individual levels. The main survey: modelling the “tariff”: to interpolate values for the remaining 200 EuroQol states from the 45 on which we had direct valuations, the preferred model (known as “Dolan-N3”) predicts the value of a health state from its components by attaching a (negative) value to each separate deviation from good health. Our basic tariff, for use when a weighting system is required for use in an economic evaluation, is the one of mean values based on the individual TTO scores. Not everyone may wish to use this basic tariff, though we recommend for comparative purposes that even if another one of preferred, the basic one is used too. The next phase: the main future activity of the MVH Group is going to be the implementation of the benefit measures we have already generated. This is our next challenge.

Suggested Citation

  • Alan Williams, 1995. "A measurement and validation of health: a chronicle," Working Papers 136chedp, Centre for Health Economics, University of York.
    • Handle: RePEc:chy:respap:136chedp
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    File URL: http://www.york.ac.uk/media/che/documents/papers/discussionpapers/CHE%20Discussion%20Paper%20136.pdf
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    References listed on IDEAS

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    1. Stephen J Wright, 1986. "Age, sex and health: a summary of findings from the York Health Evaluation Survey," Working Papers 015chedp, Centre for Health Economics, University of York.
    2. Torrance, George W., 1976. "Social preferences for health states: An empirical evaluation of three measurement techniques," Socio-Economic Planning Sciences, Elsevier, vol. 10(3), pages 129-136.
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    Cited by:

    1. Benjamin M. Craig & A. Simon Pickard & Elly Stolk & John E. Brazier, 2013. "US Valuation of the SF-6D," Medical Decision Making, , vol. 33(6), pages 793-803, August.

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