Cost Effectiveness Analysis Of Application Research Of The Measuring Methods Of Utility Value

BACKGROUND AND OBJECTIVE:As one method of pharmacoeconomics evaluation, cost-utility analysis has comparability for that its utility combines quality and quantity, and has a great prospect for development, and its development in foreign countries is becoming increasingly popular. Utilities are typically combined with survival estimates and aggregated across individuals to generate quality adjusted life-years (QALYs) for use in cost-utility analyses of healthcare interventions. Cost-utility analysis is still used seldom in our country, the reason for it may be a fact that utility measurement methods, especially indirect measurement methods have not yet been to promote and popularize, which are also called multi-attribute health status classification systems, and have become the trend of utility measurement methods. The purposes of this study were to review the main important contents about utility measurement and to provide some advices for the relevant study in our country.METHODS:bibliometric analysis was used to evaluate journal literature on utility measurement methods over the past decade, so as to obtain the characteristics of relevant literature, and to better guide the development of health economics research in this area; literature induction was used to summarize the types, characteristics, application, existing problems and current solutiongs of utility methods, in order to provide a reference about valuing health utility in cost-utility analysis for Chinese scholars.RESULTS:1, the result of electronic search showed that since2002the number of articles on utility measurement has been increasing in the past decade; the published literature in English accounted for the absolute dominant position,89.83%of the studies were published in English, followed by German (1.43%), Spanish (0.89%); the preferred core journals in this field were "Value Health","Pharmacoeconomics","Qual Life Res","Med Decis Making and Health Technol Assess "; Brazier J was an important researcher, expert and academic leader in the field of utility measurement; the United States, Britain and Canada were the three core States that studied utility measurement methods; universities played an active role in exploring the valuation methods of health utility for cost-utility analysis.2, the methods that have been used to collect data on utilities include the standard gamble approach, the time trade-off approach and the visual analogue approach. The choice of method matters as the differences in theoretical grounding and valuation approach can lead to differences in utility estimates. In general, health economists support the use of choice-based methods (SG or TTO) over the VAS. Based on normative expected-utility arguments, the standard gamble (SG) method has often been considered the gold standard for utility measurement because, unlike other elicitation methods, it incorporates risk. However, the SG approach is relatively time-consuming and people often have difficulty understanding the concept of probabilities. For many, the TTO represents a reliable and practical middle way, although the trade-off concept could still be difficult for many people to understand.3, the main indirect methods of utility measurement are:the use of generic preference instruments (EQ-5D, SF-6D, HUI and QWB); the use of disease-specific preference measures; and mapping from a disease-specific health-related quality of life instrument to a generic instrument. The four generic preference instruments, EQ-5D, SF-6D, HUI and QWB are different in health dimensions and the corresponding level numbers, description of level, valuation methods of preference, scoring functions, and populations, and therefore when valuing the same heath state the results are different.4, direct methods of utility measurement are the basis of indirect methods, the indirect methods of utility measurement can be administrated more easily than TTO and SG, respondents can complete the questionnaires within a few minutes. Another advantage of generic preference instruments is that, from the perspective of decision makers, the derived preference values can be used to compare the QALYs after the intervention between different disease groups or diseases, so as to help the decision-making and the allocation of health services resource.5, there are some difficulty and problems in the application of utility measurement which we should pay attention to, including utility measurement for the pediatric population, the utility differences between the patients and general public, the utility measurement of temporary health state, the factors influencing the measurement results of utility.CONCLUSIONS:This review of utility measurement methods has revealed that the indirect methods, especially the generic preference instruments, are the important methods currently. We should select a preference assessment method based on the study purpose and the characteristics of each measure. In the clinical trial, the best choice of methods depends on the measuring object, complexity of the intervention, health status to be measured, time frame, as well as the availability of research resources. We recommend that researcher should evaluate existing literature on preference assessment measures that have been used in a similar population. The evaluation should allow selection of the least burdensome measure that meets psychometric and other criteria. The measure should be valid, reliable, and responsive among patients with the disease to be studied.