Evaluating Utility Measures: Biases and Alternatives

描述（由申请人提供）：成本效益和成本效用分析（CEA/CUA）越来越多地用于卫生和医学的临床和政策决策。公用事业是经济分析的关键输入，为常见的结果测量“质量调整寿命年”提供加权因子。测量的准确性和有效性以及效用测量的应用对于从这种分析中产生有意义和信息丰富的结果至关重要。拟议的研究将为理解现有效用测量方法的适当使用和应用提供见解，并指导改进和替代方案的发展。它将侧重于癌症，这是一种在临床决策和政策中对生活质量影响特别重要的疾病。本研究提出了一系列的研究，以调查效用的测量，探索效用的应用，并制定指导方针，以改进效用评估方法。第一项研究将采用调查研究和过程追踪方法来识别在效用评估方法中产生偏差的认知因素，并开发和测试修改以避免此类偏差。第二项研究将使用元分析技术确定公用事业是否因个人年龄、种族和性别而系统性地变化。这项研究最终将提出使用现有效用测量方法和价值的建议，并为开发评估健康的新方法构建一个框架。这项研究的一个有用的副产品将是CEA/CUA和其他应用研究人员对癌症健康状态的效用值的估计。该候选人在其博士论文、博士后研究中研究了偏好和效用评估方法及其应用，目前在马萨诸塞州总医院和哈佛医学院担任讲师。她开始了作为生活质量方法学家的职业生涯，专注于癌症干预。这个职业发展奖将有助于她开始独立的研究议程。她的职业发展将由她所在部门的主任，MGH技术评估研究所的主任，以及与候选人建立了工作关系的该领域的高级研究人员（包括她的论文和博士后导师）指导。她有强大的机构支持和教师指导，以保证她在拟议的研究中取得成功。

DESCRIPTION (provided by the applicant): 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 understanding 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.