Measurement of utilities and quality-adjusted survival

Quality-adjusted survival as a measure of the effectiveness of medical interventions captures the tradeoffs between length and quality of life that are often involved in choosing between alternative treatment strategies. Until recently, the utilities needed to calculate quality-adjusted survival were generally estimated by experts; however, there is growing interest in collection of empiric utility data in the clinical trial and clinical practice settings. The classic approaches to direct utility assessment are difficult to administer and have questionable psychometric properties. Health state classification indices offer a promising alternative approach that relies on patients as the source of information regarding the health-related quality of life impact of a given health state while providing utility estimates suitable for guiding treatment and resource allocation decisions.