A comparison of HUI2 and HUI3 utility scores in Alzheimer's disease.
OBJECTIVE
The Health Utilities Index (HUI) is a generic, multiattribute, preference-based health-status classification system. The HUI Mark 3 (HUI3) differs from the earlier HUI2 by modifying attributes and allowing more flexibility for capturing high levels of impairment. The authors compared HUI2 and HUI3 scores of patients with Alzheimer's disease (AD) and caregivers, and contrasted results of a cost-effectiveness analysis of new drugs for AD using the two systems.


METHODS
In a cross-sectional study of 679 AD patient/caregiver pairs, stratified by patient's disease stage (questionable/mild/moderate/severe/profound/terminal) and setting (community/assisted living/nursing home), caregivers completed the combined HUI2/HUI3 questionnaire as proxy respondents for patients and for themselves.


RESULTS
Mean (SD) global utility scores for patients were lower on the HUI3 (0.22[0.26]) than on the HUI2 (0.53 [0.21]). Patient HUI3 utility scores ranged from 0.47(0.24) for questionable AD to -0.23 (0.08) for terminal AD, compared with a range of 0.73 (0.15) to 0.14 (0.07) for the HUI2. Among the 203 patients in the severe, profound, and terminal stages, 96 (48%) had negative global HUI3 utility scores, while none had a negative HUI2 score. The utility scores for caregivers were similar on the HUI3 (0.87 [0.14]) and HUI2 (0.87 [0.11]). Cost-effectiveness analysis of a new medication to treat AD showed somewhat more favorable results using the HUI3.


CONCLUSIONS
The HUI2 and HUI3 discriminate well across AD stages. Compared with the HUI2, the HUI3 yields lower global utility scores for patients with AD, and more scores for states judged worse than dead. The HUI3 may yield substantially different results from the HUI2, particularly for persons who have serious cognitive impairments such as AD.
Neumann
P J
PJ
Program on the Economic Evaluation of Medical Technology, Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts 02115, USA. pneumann@hsph.harvard.edu
Sandberg
E A
EA
Araki
S S
SS
Kuntz
K M
KM
Feeny
D
D
Weinstein
M C
MC
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy; D017028:Caregivers; D002800:Cholinesterase Inhibitors / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000077265:Donepezil; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007189:Indans / Q000191:economics / Q000627:therapeutic use; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018697:Nootropic Agents / Q000191:economics / Q000627:therapeutic use; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D002800:Cholinesterase Inhibitors; D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil