Patient utilities for advanced cancer: effect of current health on values

Utilities are critical inputs to economic analyses, yet some things remain unclear about their elicitation and application, particularly the impact of health status on values. Prospect theory predicts that current health affects values, and that losses loom larger than gains. If true, the use of utilities requires that additional complexities be considered.

To determine the effect of current health on patient utilities for advanced cancer health states.

The research was a cross-sectional survey (n=100 patients) of utilities for 4 hypothetical advanced cancer health states. Chained gamble utilities for gains and losses in health were compared, correlations between current health status and utilities were measured, and patient utilities for experienced versus hypothetical health states were compared.

In this sample, gains in health were valued equivalently to losses, health status was not correlated with utility values, and patients' valuation of states equivalent to their current health did not differ from valuations of the same states by patients with better or worse current health.

This research confirms the uncertainty surrounding the effect of health status on utilities and the question of whose values to use in analyses. The findings suggest that values for health states may be independent of current health status, supporting an objective view of utilities. This research also suggests that patients may be able to provide "experienced utilities" for states other than their own, expanding the population from whom such values can be elicited. These results may dispute prospect theory's predictions regarding health state valuations.