Using rank and discrete choice data to estimate health state utility values on the QALY scale

J Brazier, D Rowen, Y Yang, A Tsuchiya


Recent years have seen increasing interest in the use of ordinal methods to elicit health state utility values as an alternative to conventional methods such as standard gamble and time trade-off (TTO). However, in order to use these ordinal methods to produce health state values for use in cost-effectiveness analysis using cost per quality adjusted life year (QALY) analysis, these values must be anchored on the full health-dead scale. The paper reports on two feasibility studies that use two approaches to anchor health state utility values derived from discrete choice data on the full health-dead scale: normalising using (1) the TTO value of the worst state and (2) the coefficient on the ‘dead’ dummy variable. Health state utility values obtained using rank and discrete choice data are compared to more commonly used TTO utility values for two condition-specific preference-based measures; asthma and overactive bladder. Ordinal methods were found to offer a promising alternative to conventional cardinal methods of standard gamble and TTO. There remains a large and important research agenda to address.