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Predicting Utility Ratings for Joint Health States from Single Health States in Prostate Cancer: Empirical Testing of 3 Alternative Theories

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Listed:
  • William Dale

    (University of Chicago, Department of Medicine, Section of Geriatrics, wdale@medicine.bsd.uchicago.edu.)

  • Anirban Basu

    (Section of General Internal Medicine Chicago, Illinois)

  • Arthur Elstein

    (University of Illinois-Chicago, Department of Medical Education)

  • David Meltzer

    (Section of General Internal Medicine Chicago, Illinois)

Abstract

Background. Cost-effectiveness analyses measure quality of life by associating utilities with specific health states. Utilities are often defined by single health states, such as incontinence or impotence in the case of prostate cancer treatments. Health conditions often occur simultaneously, yielding joint health states (e.g., impotence with incontinence). Given the combinatorial mathematics involved, even a small number of conditions can result in large numbers of potential joint states, complicating utility elicitation for all relevant states. Analytic predictions for joint-state utilities have been based on 3 theoretical models: 1) multiplicative, 2) additive, and 3) minimum models. These models' empirical accuracy for joint-state utility prediction has been minimally examined. The authors compared these 3 models for predicting joint-state utilities from single-state utilities in men at the time of prostate biopsies. Methods. Utilities were collected using time tradeoff in 2 university-based prostate biopsy clinics (N = 147). Single-state utilities were elicited for impotence, incontinence, watchful waiting, and post-prostatectomy. Joint-state utilities were elicited for states combining impotence with 1) incontinence, 2) postprostatectomy, or 3) watchful waiting. Testing 3 prediction models of joint-state utilities for bias and consistency, the predictions were compared against directly elicited joint-state utilities. Results. All 3 models are biased. The minimum model is preferred, being the least biased and most efficient. Conclusions. No current model accurately predicts joint-state utility using the component single-state utilities. When possible, joint-state utilities should be elicited. If not possible, the minimum model is recommended. Research to identify better models is needed.

Suggested Citation

  • William Dale & Anirban Basu & Arthur Elstein & David Meltzer, 2008. "Predicting Utility Ratings for Joint Health States from Single Health States in Prostate Cancer: Empirical Testing of 3 Alternative Theories," Medical Decision Making, , vol. 28(1), pages 102-112, January.
  • Handle: RePEc:sae:medema:v:28:y:2008:i:1:p:102-112
    DOI: 10.1177/0272989X07309639
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    References listed on IDEAS

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    1. Keeney,Ralph L. & Raiffa,Howard, 1993. "Decisions with Multiple Objectives," Cambridge Books, Cambridge University Press, number 9780521438834, October.
    2. Mas-Colell, Andreu & Whinston, Michael D. & Green, Jerry R., 1995. "Microeconomic Theory," OUP Catalogue, Oxford University Press, number 9780195102680.
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    Cited by:

    1. Anirban Basu & William Dale & Arthur Elstein & David Meltzer, 2009. "A linear index for predicting joint health‐states utilities from single health‐states utilities," Health Economics, John Wiley & Sons, Ltd., vol. 18(4), pages 403-419, April.
    2. William Raich & Jennifer Baxter & Megan Sheahan & Jeremy Goldhaber-Fiebert & Patrick Sullivan & Janel Hanmer, 2023. "Estimates of Quality-Adjusted Life-Year Loss for Injuries in the United States," Medical Decision Making, , vol. 43(3), pages 288-298, April.
    3. Roberta Ara & Allan J. Wailoo, 2013. "Estimating Health State Utility Values for Joint Health Conditions," Medical Decision Making, , vol. 33(2), pages 139-153, February.
    4. Kurinchi Gurusamy & Edward Wilson & Andrew Burroughs & Brian Davidson, 2012. "Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones," Applied Health Economics and Health Policy, Springer, vol. 10(1), pages 15-29, January.
    5. Ara, Roberta & Brazier, John, 2009. "Populating an economic model with health state utility values: moving towards better practice," MPRA Paper 29896, University Library of Munich, Germany.

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