Evaluating Utility Measures: Biases and Alternatives

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Cost-effectiveness and cost-utility analysis (CEA/CUA) is increasingly used for clinical and policy decision making in health and medicine. Utilities are critical inputs to economic analyses, providing the weighting factor for the common outcome measure "quality adjusted life years." The accuracy and validity of measurement and application of utility measures are essential to producing meaningful and informative results from such analyses. The proposed research will provide insight to understand the appropriate use and application of existing utility measurement methods, and to guide the development of improvements and alternatives. It will focus on cancer, a disease for which quality of life effects are of particular importance in clinical decision making and policy. The research proposes a series of studies to investigate the measurement of utilities, to explore the application of utilities, and to develop guidelines for improvements in utility assessment methodology. The first study will employ survey research and process tracing methods to identify cognitive factors that create biases in utility assessment methods, and develop and test modifications to avoid such biases. The second study will determine whether utilities vary systematically by individuals' age, race and gender using meta analytic techniques. The research will culminate in recommendations for the use of existing utility measurement methods and values, and the construction of a framework for the development of new methods to value health. A useful by-product of the research will be estimates of utility values for cancer health states for use by CEA/CUA and other applied researchers. The candidate has studied preference and utility assessment methods and their application in her dissertation, post-doctoral research, and current position as Instructor at Massachusetts General Hospital and Harvard Medical School. She is beginning a career as a quality of life methodologist, focusing on cancer interventions. This career development award would contribute to the initiation of her independent research agenda. She will be guided in her career development by the Director of her department, the MGH Institute for Technology Assessment, as well as senior researchers in this field who have established working relationships with the candidate (including her dissertation and post-doctoral advisors). She has strong institutional support and faculty mentorship to guarantee her success in the proposed research.