“Utilities” can broadly be defined as methods to measure health outcomes using preferences (either an individual’s or societal). In this way researchers can examine not just a quantity of life-years gained from an intervention, but the quality of that time. Cost utility analysis (CUA) permits the evaluation of health outcomes adjusted by patient preferences. For example, using CUA, researchers may compare the value of extending a life versus the side effects of the intervention.
There are many different approaches to developing preference-based algorithms for utility assessment; the most widely used health outcomes utility measure is the Quality Adjusted Life Year (QALY). However, because preferences/utilities are subjective, they can be influenced by many factors including culture, disease, or costs. Because QALY’s are calculated using individual patient preferences calculated using Time-Trade-Off or Standard-Gamble techniques (among others), the results may vary considerably based on changes in time or condition. QALY’s have been criticized as being overly sensitive to the population from which they are derived, and therefore not being a legitimate metric of larger societal health utilities, or social value.
More recent work has developed Multi Attribute Utility Instruments (MAUI’s). Given the unique preferences of varying patient populations, there are ongoing discussions of the value of disease- and country-specific MAUI’s.
Recommendations: Our current thinking is that the Dr. Madeline King’s 2016 effort has produced the best direct measure (the FACT-8D). But there remains insufficient evidence for us to make a specific recommendation for a ‘mapping’-based measure at this time.
Select FACT/FACIT Utilities Citations
Other FACT Measures:
Kind P, Macran S. Eliciting social preference weights for Functional Assessment of Cancer
Therapy-Lung health states Pharmacoeconomics 2005;23:1143–53. DOI: 10.2165/00019053-200523110-00006 PMID: 16277549
J Patient Rep Outcomes. 2020 Mar 27;4(1):22. Herdman M, Kerr C, et al. Testing the validity and responsiveness of a new cancer-specific health utility measure (FACT-8D) in relapsed/refractory mantle cell lymphoma, and comparison to EQ-5D-5L. DOI: 10.1186/s41687-020-0185-3