Incorporating Mortality in Health Utility Measures

Area of Science:

• Health economics
• Decision analysis
• Psychometrics

Background:

• Multiattribute health utility systems rely on design choices impacting utility models.
• An unrecognized design choice involves scaling essential outcomes outside the multiattribute space, such as the state of being dead.

Purpose of the Study:

• To identify and describe an unrecognized design choice in multiattribute health utility systems.
• To analyze the impact of different approaches to scaling the utility of being dead on health state valuations.

Main Methods:

• Examined the process of determining the utility of being dead within multiattribute health utility frameworks.
• Investigated two distinct approaches for scaling the utility of being dead and the all-worst state.
• Applied these approaches to the Health Utility Index 3 (HUI3) system.

Main Results:

• Two unrecognized methods exist for scaling the utility of being dead, yielding different results.
• The choice of method significantly alters the proportion of health states classified as worse than dead.
• In HUI3, one method rates 78% of states as worse than dead; an alternative method increases this to 85%.

Conclusions:

• The scaling of the state of being dead is a critical, yet often overlooked, researcher degree of freedom in utility measure design.
• This choice has substantial implications for health state valuations, particularly in populations with high morbidity.
• Awareness of these scaling approaches is crucial for accurate and consistent health utility assessments.