Application of discrete choice experiments to value multi-attribute health states for use in economic evaluation

经济评估越来越多地被医疗保健决策者用来决定哪些医疗保健计划在改善人们的健康和生活质量方面提供了最好的性价比。它被澳大利亚政府用来决定哪些医疗服务和药品应该得到资助。这需要以一种允许跨治疗进行比较的方式来衡量生活质量，并需要一种量化不同健康状态的社区偏好的手段(即，我们如何评估健康结果)。通常使用质量调整生命年(QALY)来评估健康结果，QALY在单一衡量标准中结合了生命长度和质量。要比较不同的疾病和治疗方法，生活质量必须以同样的方式衡量。这可以通过使用一套涵盖生活质量不同方面(如疼痛、活动能力、情绪状态)的标准问题来完成。通过这种方式，单一的调查工具可以用于任何疾病或治疗结果。我们也可以使用同样的工具来要求公众提供关于他们对不同健康状况的偏好的信息(这就是他们如何评估健康结果)。然而，从受访者那里获得这些信息是复杂的，关于哪些是评估健康结果的最佳工具和最佳方法存在争议。在这项研究中，我们提出了一种评估健康状态的新方法，这种方法更容易管理，并允许对人们给出的反应进行更详细和严格的分析，以提供更好的模型，说明生活质量的不同方面是如何结合在评估健康结果的。我们将把新方法与现有的主要方法进行比较。我们将对两种在医疗保健研究中广泛使用的标准生活质量工具的方法进行比较。这项研究还将提供澳大利亚人口健康状况的评估，然后可用于经济评估。

Economic evaluation is used increasingly by health care decision makers to decide which health care programs provide the best value for money, in terms of improving health and quality of life outcomes for the population. It is used by the Australian government in deciding which medical services and pharmaceuticals should be funded. This requires measurement of quality of life in a way that allows comparison across treatments, and a means of quantifying community preferences for different health states (that is, how we value health outcomes). Health outcomes are often valued using the quality adjusted life year (QALY) which combines length and quality of life in a single measure. To compare across diseases and treatments, quality of life must be measured in the same way. This can be done by using a standard set of questions that cover the different aspects of quality of life (eg pain, mobility, emotional state). In this way, a single survey instrument can be used for any disease or outcome of treatment. We can also use the same instrument to ask members of the public to provide information about their preferences for different health states (that is how they value health outcomes). However, obtaining this information from respondents is complex, and there is debate about which are the best instruments, and the best methods to value health outcomes. In this research, we propose a new approach to valuing health states, which is easier to administer and which allows for more detailed and rigorous analysis of the responses people give, to provide better models of how the different aspects of quality of life are combined in valuing health outcomes. We will compare the new method with the main existing methods. We will compare these methods for two standard quality of life instruments that are widely used in health care research. The research will also provide valuations of health states from the Australian population that can then be used in economic evaluation.