title: Assessing differences in utility scores: a comparison of four widely used preference-based instruments.
abstract: OBJECTIVE
  To characterize the differences in utility scores (dUTY) among four commonly used preference-based Health-Related Quality of Life instruments, to evaluate the potential impact of these differences on cost-utility analyses (CUA), and to determine if sociodemographic/clinical factors influenced the magnitude of these differences.
  
  
  METHODS
  Consenting adult Chinese, Malay and Indian subjects in Singapore were interviewed using Singapore English, Chinese, Malay or Tamil versions of the EQ-5D, Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), and SF-6D. Agreement between instruments was assessed using Bland-Altman (BA) plots. Changes in incremental cost-utility ratio (ICUR) from dUTY were investigated using eight hypothetical decision trees. The influence of sociodemographic/clinical factors on dUTY between instrument pairs was studied using multiple linear regression (MLR) models for English-speaking subjects (circumventing structural zero issues).
  
  
  RESULTS
  In 667 subjects (median age 48 years, 59% female), median utility scores ranged from 0.80 (95% confidence interval [CI] 0.80, 0.85) for the EQ-5D to 0.89 (95% CI 0.88, 0.89) for the SF-6D. BA plots: Mean differences (95% CI) exceeded the clinically important difference (CID) of 0.04 for four of six pairwise comparisons, with the exception of the HUI2/EQ-5D (0.03, CI: 0.02, 0.04) and SF-6D/HUI2 (0.02, CI: 0.006, 0.02). Decision trees: The ICER ranged from $94,661/QALY (quality-adjusted life-year; 6.3% difference from base case) to 100,693 dollars/QALY (0.3% difference from base case). MLR: Chronic medical conditions, marital status, and Family Functioning Measures scores significantly (P-value < 0.05) influenced dUTY for several instrument pairs.
  
  
  CONCLUSIONS
  Although CIDs in utility measurements were present for different preference-based instruments, the impact of these differences on CUA appeared relatively minor. Chronic medical conditions, marital status, and family functioning influenced the magnitude of these differences.
authors.affiliation: Singapore General Hospital, Singapore.
authors.forename: Hwee-Lin
authors.initials: HL
authors.lastname: Wee
authors.forename: David
authors.initials: D
authors.lastname: Machin
authors.forename: Wai-Chiong
authors.initials: WC
authors.lastname: Loke
authors.forename: Shu-Chuen
authors.initials: SC
authors.lastname: Li
authors.forename: Yin-Bun
authors.initials: YB
authors.lastname: Cheung
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
authors.forename: David
authors.initials: D
authors.lastname: Feeny
authors.forename: Kok-Yong
authors.initials: KY
authors.lastname: Fong
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003663:Decision Trees; D003710:Demography; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires