title: Utility scores for vesicoureteral reflux and anti-reflux surgery.
abstract: BACKGROUND
  Management of vesicoureteral reflux (VUR) continues to be controversial. In conditions of uncertainty, decision analytic techniques such as cost-utility analysis (CUA) can help to structure the decision-making process. However, CUA analyses require a "utility," a value between 0 (death) and 1 (perfect health) corresponding to the quality of life associated with a health state. Ideally, utility values are elicited directly from representative community samples, but utilities have not been rigorously measured for pediatric urology conditions.
  
  
  OBJECTIVE
  To elicit utility scores for VUR and open anti-reflux surgery (ARS) from a representative, well-characterized community sample of adults who have been parents.
  
  
  METHODS
  Cross-sectional survey of nationally representative adults who had ever been parents. Each respondent saw one of four descriptions of VUR, with or without continuous antibiotic prophylaxis (CAP) and occurrence of febrile urinary tract infection (UTI). A 6-week postoperative health state following ARS was also assessed. We used the time trade-off (TTO) method to elicit utility scores. Factors associated with utility score were assessed with a multivariate linear regression model.
  
  
  RESULTS
  The survey was completed by 1200 individuals. Data were weighted to adjust for demographic differences between responders and non-responders. Mean age was 52 ± 15 years, 44% were male, and 68% were White. In terms of education, 29% had a college degree or higher. The mean utility score for VUR overall was 0.82 ± 0.28. VUR utility scores did not differ significantly based on inclusion of CAP or UTI in the health state description (p = 0.21). The 6-week postoperative period garnered a utility of 0.71 ± 0.43.
  
  
  CONCLUSIONS
  Our results showed that VUR has a mean utility score of 0.82, which indicates that the community perceives this condition to be a substantial burden. For comparison, conditions with similar utility scores include compensated hepatitis B-related cirrhosis (0.80) and glaucoma (0.82); conditions with higher utilities include neonatal jaundice (0.99) and transient neonatal neurological symptoms (0.95); and conditions with lower utility scores include severe depression (0.43) and major stroke (0.30). Our results suggest that parents consider the burden associated with VUR to be significant, and that the impact of the condition on families and children is substantial.
  
  
  CONCLUSIONS
  VUR is perceived as having a substantial impact on health-related quality of life, with a utility value of 0.82. However, use of CAP and occurrence of UTI do not seem to affect significantly the community perspective on HRQOL associated with living with VUR.
authors.affiliation: Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: caleb.nelson@childrens.harvard.edu.
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
authors.affiliation: Division of Urology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.affiliation: Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Logvinenko
authors.affiliation: Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Ilina
authors.initials: I
authors.lastname: Rosoklija
authors.affiliation: Division of Urology, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kokorowski
authors.affiliation: CHEAR Unit, General Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D055815:Young Adult
keywords: Pediatric; Urology; Utility; Vesicoureteral reflux