Health state values from multiattribute utility instruments need correction

Area of Science:

• Health Economics
• Decision Science
• Public Health Policy

Background:

• Cost-utility analysis (CUA) is a standard method for assessing health intervention value.
• Quality-adjusted life year (QALY) is the primary metric in CUA, ranging from 0 (death) to 1 (perfect health).
• Multiattribute utility (MAU) instruments are commonly used to derive QALY scores.

Purpose of the Study:

• To introduce a refined approach to economic evaluation in healthcare.
• To enhance CUA by incorporating societal concerns for equity.
• To provide a method for transforming utility scores to reflect priority for the worst-off.

Main Methods:

• Conventional cost-utility analysis using standard MAU instrument outputs.
• Cost-value analysis (CVA) involving transformation of utility scores.
• Development of a preliminary figure to guide utility score transformations for equity considerations.

Main Results:

• Demonstration of two distinct analytical approaches: conventional CUA and the broader CVA.
• Introduction of a method to adjust QALYs for equity, prioritizing disadvantaged populations.
• Presentation of a tool to facilitate the practical application of CVA.

Conclusions:

• The proposed cost-value analysis offers a more comprehensive framework for health economic evaluation.
• Transforming QALYs can better align health intervention assessments with societal values, particularly equity.
• The presented figure serves as a practical aid for researchers implementing cost-value analysis.