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Measuring the Subjective Value of Risky and Ambiguous Options using Experimental Economics and Functional MRI Methods

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Can multi-attribute utility instruments adequately account for subjective well-being?

Jeff Richardson¹, Gang Chen², Munir A Khan¹

¹Centre for Health Economics, Monash Business School, Monash University, Clayton, Australia (JR, MAK, AI)

Medical Decision Making : an International Journal of the Society for Medical Decision Making

|January 28, 2015

Summary

Multi-attribute utility instruments (MAUIs) often fail to capture subjective well-being (SWB) because their descriptive systems omit key health elements. Improving MAUI design can better account for SWB in health economic evaluations.

Keywords:

multiattribute utility instrument.subjective well-being utility

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Area of Science:

Health Economics
Psychometrics
Quality of Life Research

Background:

Quality of life is integral to cost-utility analyses, using health state utilities.
Existing multi-attribute utility instruments (MAUIs) show poor correlation with subjective well-being (SWB).
This suggests MAUIs may not fully capture patient-experienced SWB.

Purpose of the Study:

To investigate if MAUI descriptive systems adequately include health elements crucial for SWB.
To explore the hypothesis that MAUI limitations in accounting for SWB stem from omissions in their descriptive systems.

Main Methods:

Analysis of survey data from 6 MAUIs across 7 disease areas.
Comparison of MAUI predictions with SWB of healthy individuals and patients.
Assessment of how well MAUI descriptive systems explain SWB variations.

Main Results:

EQ-5D-5L accounted for the least SWB, while AQoL-8D accounted for the most.
AQoL-8D occasionally overpredicted SWB loss in cases of hedonic adaptation.
Utility measures can largely account for SWB variation when MAUIs include relevant health elements.

Conclusions:

The omission of SWB-determining health elements in MAUI descriptive systems contributes to their limitations.
Enhancing MAUI descriptive systems to incorporate these elements is crucial for accurate economic evaluations.
SWB should be more comprehensively integrated into health utility assessments.