Skip to main content
×
Home
    • Aa
    • Aa

Utilities and Quality-Adjusted Life Years

  • George W. Torrance (a1) and David Feeny (a1)
Abstract

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.

Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

Copyright
References
Hide All
Albert D. A. Decision theory in medicine: A review and critique. Milbank Memorial Quarterly, 1978, 56, 362401.
Allais M. & Hagen O. (eds.). Expected utility hypotheses and the Allais Paradox. Dordrecht, Holland: Reidel, 1979.
Anderson J. P., Bush J. W., Chen M. & Dolenc D. Policy space areas and properties of benefit-cost/utility analysis. Journal of the American MedicalAssociation, 1986, 255, 794–95.
Arrow K. J. & Debreu G. Existence of equilibrium for a competetive economy. Econometrica 1954, 22, 265–90.
Bell D. E. & Farquhar P. H. Perspectives on utility theory. Operations Research, 1986, 34, 179–83.
Berg R. L. Establishing the values of various conditions of life for a health status index. In Berg R. L. (ed.), Health status indexes. Chicago, IL: Hospital Research and Educational Trust, 1973, 120–34.
Bombardier C., Ware J., Russell I. J. et al. , Auranofin therapy and quality of life in patients with rheumatoid arthritis: Results of a multicenter trial. American Journal of Medicine, 1986, 81, 565–78.
Boyle M. H., Torrance G. W., Sinclair J. C. & Horwood S. P. Economic evaluation of neonatal intensive care of very low birth-weight infants. New England Journal of Medicine, 1983, 308, 1330–37.
Brookshire D. S., Thayer M. A., Tschirhart J. & Schulze W. D. A test of the expected utility model: Evidence from earthquake risks. Journal of Political Economy, 1985, 93, 369–89.
Bush J. W., Chen M. M. & Patrick D. L. Health status index in cost effectiveness: Analysis of PKU program. In Berg R. L. (ed.), Health status indexes. Chicago, IL: Hospital Research and Educational Trust, 1973, 172209.
Bush J. W., Fanshel S. & Chen M. M. Analysis of a tuberculin testing program using a health status index. Socio-Economic Planning Science, 1972, 6, 4968.
Buxton M., Ashby J. & O'Hanlon M. Valuation of health states using the time trade-off approach. HERG Discussion Paper #2. Uxbridge, Middlesex: Brunel University, Health Economics Research Group, 1986.
Churchill D. N., Torrance G. W., Taylor D. W. et al. , Measurement of quality of life in end-stage renal disease: The time trade-off approach. Clinical Investigative Medicine, 1987, 10, 1420.
Drummond M. F., Stoddart G. L. & Torrance G. W. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987.
Dyer J. S. & Sarin R. K. Group preference aggregation rules based on strength of preference. Management Science, 1979, 25, 822–32.
Fanshel S. & Bush J. W. A health status index and its application to health services outcomes. Operations Research, 1970, 18, 1021–66.
Farquhar P. H. Utility assessment methods. Management Science, 1984, 30, 1283–300.
Feeny D. & Furlong W. The utility approach to the measurement of health-related quality of life. In Shumaker S. A., Furberg C. D., Czajkowski S. & Schron E. (eds.), Quality of life and cardiovascular disease. In press.
Feeny D., Guyatt G. & Tugwell P. (eds.). Health care technology: Effectiveness, efficiency and public policy. Montreal: The Institute for Research and Public Policy, 1986.
Feeny D. & Torrance G. W. Incorporating utility-based quality-of-life assessment measures in clinical trials: Two examples. Medical Care, 1989, 27 (Suppl. 3), S190–S204.
Fischer G. W. Utility models for multiple objective decisions: Do they accurately represent human preferences? Decision Sciences, 1979, 10, 451–79.
Furlong W., Feeny D., Torrance G. W. et al. , Guide to design and development of health state utility instrumentation. Working paper. Hamilton, Ontario: McMaster University Centre for Health Economics and Policy Analysis. 1990.
Guyatt G. H., Drummond M., Feeny D. et al. , Guidelines for the clinical and economic evaluation of health care technologies. Social Science and Medicine, 1986, 22, 393408.
Hagen O. & Wenstop F. (eds.) Progress in utility and risk theory. Dordrecht, Holland: Reidel, 1984.
Harsanyi J. Nonlinear social welfare functions. Theory and Decision, 1975, 6, 311–32.
Hershey J. C., Kunreuther H. C. & Schoemaker P. J. H. Sources of bias in assessment procedures for utility functions. Management Science, 1982, 28, 936–54.
Hey J. Uncertainty in microeconomics. New York: New York University Press, 1979.
Hildrith C. Alternative conditions for social orderings. Econometrica, 1953, 21, 8194.
Holloway C. A. Decision making under uncertainty: Models and choices. Engelwood Cliffs, NJ: Prentice-Hall, 1979.
Howard R. A. Decision analysis: Practice and promise. Management Science, 1988, 34, 679–95.
Kahneman D., Slovic P. & Tversky A. (eds.) Judgments under uncertainty: Heuristics and biases. Cambridge, England: Cambridge University Press, 1982.
Kalai E. & Schmeidler D. Aggregation procedure for cardinal preferences: A formulation and proof of Samuelson's impossibility conjecture. Econometrica, 1977, 45, 1431–38.
Kassirer J. P., Moskowitz A. J., Lau J. & Pauker S. G. Decision analysis: A progress report. Annals of Internal Medicine, 1987, 106, 275–91.
Keeler E. B. & Cretin S. Discounting of life-saving and other nonmonetary effects. Management Science, 1983, 29, 300–06.
Keeney R. L. A group preference axiomatization with cardinal utility. Management Science, 1976, 23, 140–45.
Keeney R. L. Decision-analysis: an overview. Operations Research, 1982, 30, 803–38.
Keeney R. L. & Raiffa H. Decisions with multiple objectives: Preferences and value tradeoffs. New York: Wiley, 1976.
Krumins P. E., Fihn S. O. & Kent D. L. Symptom severity and patients' values in the decision to perform a transurethral resection of the prostate. Medical Decision Making, 1988, 8, 18.
Lane D. A. Utility, decision, and quality of life. Journal of Chronic Diseases, 1987, 40, 585–91.
Loomes G. & McKenzie L. The use of QALYs in health care decision making. Social Science and Medicine, 1989, 28, 299308.
Luce R. D. & Raiffa H. Games and decisions. New York: Wiley, 1957.
MacCrimmon K. R. & Larsson S. Utility theory: Axioms versus paradoxes. In Allais M. & Hagen O. (eds.), Expected utility and the Allais Paradox. Dordrecht, Holland: Reidel, 1979, 333409.
McNeil B. & Pauker S. G. Decision analysis for public health: Principles and illustrations. Annual Review of Public Health, 1984, 5, 135–61.
Mehrez A. & Gafni A. Quality-adjusted life years, utility theory, and healthy-years equivalents. Medical Decision Making, 1989, 9, 142–49
Pauker S. G. Coronary artery surgery: The use of decision analysis. Annals of Internal Medicine, 1976, 85, 8.
Pauker S. G., Torrance G. W. & McNeil B. J. Using the patient utility measurement set (PUMS) to measure health related quality of life in a clinical trial: Patient responses to alternative treatments for rheumatoid arthritis. Unpublished.
Quade E. S. Analysis for public decisions. New York: North Holland, 1982.
Raiffa H. Decision analysis: Introductory lectures on choices under uncertainty. Reading, MA: Addison-Wesley, 1968.
Read J. L., Quinn R. J., Berwick D. M. et al. , Preferences for health outcomes: Comparison of assessment methods. Medical Decision Making, 1984, 4, 315–29.
Rosser R. & Kind P. A scale of valuations of states of illness: Is there a social consensus? International Journal of Epidemiology, 1978, 7, 347–58.
Russell R. R. & Wilkinson M. Microeconomics: A synthesis of modern and neoclassical theory. New York: Wiley, 1978.
Sackett D. L. & Torrance G. W. The utility of different health states as perceived by the general public. Journal of Chronic Diseases, 1978, 31, 697704.
Samuelson W. & Zeckhauser R. Status quo bias in decision making. Journal of Risk and Uncertainty, 1988, 1, 759.
Schoemaker P. J. H. Experiments on decision under risk: The expected utility hypothesis. Boston, MA: Martinus Nijhoff, 1980.
Schoemaker P. J. H. The expected utility model: Its variants, purposes, evidence and limitation. Journal of Economic Literature, 1982, 20, 529–63.
Schwartz W. B., Gorry G. A., Kassirer J. P. et al. , Decision analysis and clinical judgment. American Journal of Medicine, 1973, 55, 459.
Slovic P. & Tversky A. Who accepts Savage's axioms? Behavioral Sciences, 1974, 19, 368–73.
Sox H. C., Blatt M. A., Higgins M. C. & Marton K.I. Medical decision making. Boston, MA: Butterworths, 1988.
Torrance G. W. Toward a utility theory foundation for health status index models. Health Services Research, 1976, 11, 349–69.
Torrance G. W. Social preferences for health states: An empirical evaluation of three measurement techniques. Socio-Economic Planning Sciences, 1976, 10, 129–36.
Torrance G. W. Measurement of health-state utilities for economic appraisal: A review. Journal of Health Economics, 1986, 5, 130.
Torrance G. W. Utility approach to measuring health-related quality of life. Journal of Chronic Diseases, 1987, 40, 593600.
Torrance G. W., Boyle M. H. & Horwood S. P. Application of multi-attribute utility theory to measure social preferences for health states. Operations Research, 1982, 30, 1043–69.
Torrance G. W., Thomas W. H. & Sackett D. L. A utility maximization model for evaluation of health care programs. Health Services Research, 1972, 7, 118–33.
Torrance G. W. & Zipursky A. Cost-effectiveness of antepartum prevention of Rh immunization. Clinics in Perinatology, 1984, 11, 267–81.
von Neumann J. & Morgenstern O. Theory of games and economic behavior. Princeton, NJ: Princeton University Press, 1944.
Weinstein M. C. Economic assessments of medical practices and technologies. Medical Decision Making, 1981, 1, 309–30.
Weinstein M. C., Fineberg H. C. et al. , Clinical decision analysis. Philadelphia, PA: W. B. Saunders, 1980.
Weinstein M. C. & Stasson W. B. Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 1977, 296, 716–21.
Williams A. Economics of coronary artery by-pass grafting. British Medical Journal, 1985, 291, 326–29.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 120 *
Loading metrics...

Abstract views

Total abstract views: 978 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd October 2017. This data will be updated every 24 hours.