title: Joint Utility Estimators in Substance Use Disorders.
abstract: BACKGROUND
  Although co-occurring conditions are common with substance use disorders (SUDs), estimation methods for joint health state utilities have not yet been tested in this context.
  
  
  OBJECTIVE
  To compare joint health state utility estimators in SUD to inform economic evaluation.
  
  
  METHODS
  We conducted two Internet-based surveys of US adults to collect community perspective standard gamble utilities for SUD and common co-occurring conditions. We evaluated six conditions as they occur individually and four combinations of these as they occur in tandem. We applied joint utility estimators using the six individual conditions' utilities to compare their performance relative to the observed combination states' utilities. We assessed performance with bias (estimated utility minus observed utility) and root mean square error (RMSE).
  
  
  RESULTS
  Using 3892 utilities from 1502 respondents, the minimum estimator was statistically unbiased (i.e., the 95% confidence interval included 0) for all combination states that we measured. The maximum estimator was unbiased for two states and the linear index and adjusted decrement estimators were unbiased for one state. The maximum estimator had the smallest RMSE for two combination states (back pain and prescription opioid misuse [0.0004] and injection crack and injection opioid use [0.0007]); the linear index and minimum estimators had the smallest RMSE for one combination state each. The additive and multiplicative estimators had the largest RMSE for all states.
  
  
  CONCLUSIONS
  Our results demonstrate the usefulness of the minimum estimator in this context, and confirm the inadequacy of the additive and multiplicative estimators. Further research is needed to extend these results to other SUD states.
authors.affiliation: Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: ewittenb@hsph.harvard.edu.
authors.forename: Eve
authors.initials: E
authors.lastname: Wittenberg
authors.affiliation: Department of Economics, University of North Carolina at Greensboro, Greensboro, NC, USA.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Bray
authors.affiliation: CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.affiliation: Department of Healthcare Policy & Research and Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Aden
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.affiliation: Department of Healthcare Policy & Research and Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D059350:Chronic Pain; D015897:Comorbidity; D003362:Cost-Benefit Analysis / Q000379:methods*; D003430:Cross-Sectional Studies; D003863:Depression; D005260:Female; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D063487:Prescription Drug Misuse; D019966:Substance-Related Disorders / Q000191:economics*; D014481:United States; D055815:Young Adult
keywords: cost-utility analysis; preferences; substance use; utility