title: Relationship between health utility and psychometric health status measures. Health values of patients infected with human immunodeficiency virus. Relationship to mental health and physical functioning. Comparison of the Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ-5D in patients treated for intermittent claudication A cost-utility analysis of laser-assisted angioplasty for peripheral arterial occlusions.
abstract: This study examined the relationship between health utility and psychometric health status measures . Utility scores derived by st and ard gamble and categorical rating methods were also compared to determine if they produce equivalent preference scales . Health status and utility was assessed in 73 chronic renal disease patients with anemia ( hematocrit less than or equal to 30 ) participating in a 48-week clinical study .  Patient preferences for current health and three hypothetical states were assessed using st and ard gamble and categorical rating procedures . St and ard gamble utility was related to home management ( P less than .05 ) ; categorical rating utility was related to home management ( P less than .05 ) , energy ( P less than .05 ) , alertness behavior ( P less than .05 ) , social interaction ( P less than .05 ) , and life satisfaction scale scores ( P less than .05 ) . Only 25 - 27 % of the variance in utility scores was explained by the health status measures . St and ard gamble utilities were consistently higher than categorical rating values for end-stage renal disease with hemodialysis ( P less than .0001 ) and severe anemia requiring blood transfusions ( P less than .0001 ) . Patient preferences for current health may be influenced in part by their functional status and well-being , risk aversion or risk-taking attitudes , and the cognitive evaluation processes involved in making judgments necessary for the measurement task , as well as their actual preferences To assess the health values of patients infected with human immunodeficiency virus ( HIV ) and examine the relationships between their health values and health status at two points in time , the authors sought to determine whether patients ' physical and mental health statuses were good predictors of how they valued their current state of health . One hundred thirty-nine patients with various stages of HIV infection were interviewed in a prospect i ve cohort study based in a primary care practice of a community-based teaching hospital . Patients were interviewed twice at 6-month intervals using three  health value measures --the time trade off , rating scale , and Quality of Well-being Scale--  and three health status measures : the  18-item Mental Health Inventory , the Dyspnea-Fatigue Index , and the Medical Outcomes Study SF-36 Health Survey .  The health status of HIV-infected patients was compromised and , with the exception of mental health , generally was worse among patients with more advanced HIV-infection . Rating scale and Quality of Well-being Scale scores were related inversely to disease stage , but time-trade off scores generally were higher regardless of disease stage . Health value measures showed moderate relationships with measures of physical functioning ( r = 0.34 - 0.68 ) but only a fair relationship with mental health ( r = 0.00 - 0.48 ) . The health status of HIV-infected patients who remained asymptomatic or remained symptomatic but without developing acquired immunodeficiency syndrome ( AIDS ) changed little over 6 months , whereas the health status of patients with AIDS and of patients manifesting progression of HIV-infection deteriorated over time . In contrast , health values , particularly time-tradeoff scores , remained stable even in the face of changes in health status and disease progression . With the exception of mental health , the impact of HIV infection on health status tends to parallel the clinical stage of disease . Health values of HIV-infected patients , however , generally are high and correlate better with physical functioning than with mental health The Health Utilities Index Mark 3 ( HUI3 ) and the EuroQol EQ-5D ( EQ-5D ) were compared to each other and to other quality -of-life ( QoL ) measures in patients treated for intermittent claudication . A total of 88 patients with intermittent claudication completed the HUI3 , EQ-5D , R AND 36-Item Health Survey 1.0 , time tradeoff , st and ard gamble , and rating scale before revascularization and at follow-up at 1 month , 3 months , and 1 year . The effect of treatment on the HUI3 and EQ-5D dimensions and the overall scores , calculated using published formulas based on societal preferences , were compared . After 1 month of treatment , the majority of patients showed improvement on the HUI3 dimensions ambulation and pain and on the EQ-5D dimensions mobility , usual activities , and pain/discomfort . The mean HUI3 score was significantly higher than the mean EQ-5D score ( 0.66 and 0.57 , respectively , p < 0.01 ) before treatment . After treatment , however , they were not significantly different from each other ( e.g. , 12 months after treatment : 0.77 and 0.75 , respectively ( p > 0.05 ) . After 1 month , the scores did not change significantly over time ( p > 0.05 ) . The intraclass correlation coefficient between changes over time in the HUI3 and EQ-5D scores was 0.30 , with other health-related quality -of-life ( HRQoL ) measures the correlations for HUI3 and EQ-5D were very similar . In conclusion , both the HUI3 and EQ-5D demonstrated an effect of treatment in patients with intermittent claudication ; in addition , they showed similar relationships with other ( HRQoL ) measures . To demonstrate the effect of revascularization in patients with intermittent claudication , however , clinicians and research ers should be aware of the differences in the mean HUI3 and EQ-5D scores Despite the perception of many people that lasers represent the cutting edge of high-technology medicine , this form of medical technology has been subject to relatively little rigorous evaluation . This dearth of research relates particularly to economic evaluation , where there have been few attempts to justify the high cost of laser equipment . This paper details an economic evaluation of the use of laser technology as a secondary adjunct to angioplasty to treat peripheral arterial occlusions . Using data from a range of sources , including a published r and omized trial , a cost-utility model is developed to estimate the costs and benefits of the laser , relative to st and ard angioplasty . The best available data indicate a cost-effective role for the laser , but important areas of uncertainty exist , including the  laser 's secondary recanalization rate , which has been estimated on the basis of limited numbers of patients . This uncertainty suggests that further research is required before widespread diffusion of the laser for use in this clinical context
target: The results of this study do not support the common view that RS values are lower than TTO values , may suggest that TTO biases largely cancel , and support the validity of formulas for correcting SG bias
background: Background .
  A common assertion is that rating scale ( RS ) values are lower than both st and ard gamble ( SG ) and time tradeoff ( TTO ) values .
  However , differences among these methods may be due to method specific bias .
  Although SG and TTOs suffer systematic bias , RS responses are known to depend on the range and frequency of other health states being evaluated .
  Over many diverse studies this effect is predicted to diminish .
  Thus , a systematic review and data synthesis of RS-TTO and RS-SG difference scores may better reveal persistent dissimilarities .
  The purpose of this study was to establish through systematic review and meta- analysis the net effect of biases that endure over many studies of utilities .