Impact of diagnosis on utilities assigned to states of illness

This paper addresses some of the fundamental issues surrounding the measurement of quality of life in relation to health care and highlights the need for continuous and careful review. Healthy volunteers were used to study the effect of diagnosis on the utilities placed on three dimensions of health-related quality of life encompassing 17 states of disability, distress, and discomfort including pain. The standard gamble (SG) was used to elicit values for appropriate levels of each dimension for selected diagnostic conditions. It was shown that clinical diagnosis affects the utilities that people assign to different states of ill-health. Mental conditions were consistently assigned lower utilities with subjects attributing their decisions to the social unacceptability and intractability associated with these conditions. These findings suggest that the comprehensiveness of the descriptive system for health indicators and profiles is important and should be kept under review. Furthermore, these data have implications for the role of the Quality Adjusted Life Years (QALY) estimates which assume that utility is uniform across various conditions. Finally, the study may have implications for mental health services if other population samples were to accord such high priority to the relief of mental conditions.