Abstract
Utility values to estimate quality-adjusted life years (QALYs) for use in cost-utility analyses are usually elicited from members of the general population. Public attitudes and understanding of dementia in particular may mean that values elicited from the general population may differ from patients and carers for dementia health states. This study examines how the population impacts utility values elicited for dementia health states using interviewer-administered time tradeoff valuation of health states defined by the dementia-specific preference-based measures DEMQOL-U (patient-report) and DEMQOL-Proxy-U (carer-report). Eight DEMQOL-U states were valued by 78 members of the UK general population and 71 patients with dementia of mild severity. Eight DEMQOL-Proxy-U states were valued by 77 members of the UK general population and 71 carers of patients with dementia of mild severity. Random-effects generalized least squares regression estimated the impact of population, dementia health state, and respondent sociodemographic characteristics on elicited values, finding that values for dementia health states differed by population and that the difference varied across dementia health states. Patients with dementia and carers of patients with dementia gave systematically lower values than members of the general population that were not due to differences in the sociodemographic characteristics of the populations. Our results suggest that the population used to produce dementia health state values could impact the results of cost-utility analyses and potentially affect resource allocation decisions; yet, currently, only general population values are available for usage.
Highlights
Utility values to estimate quality-adjusted life years (QALYs) for use in cost-utility analyses are usually elicited from members of the general population
Resource allocation decisions are increasingly being informed by cost-utility analyses measuring the benefits of treatment using the qualityadjusted life year (QALY), which captures changes in both quantity and health-related quality of life (HRQL)
The TTO utility values for dementia health states differed depending upon whether the values were elicited from patients with dementia and the carers of patients with dementia or members of the general population
Summary
Utility values to estimate quality-adjusted life years (QALYs) for use in cost-utility analyses are usually elicited from members of the general population. The validity and responsiveness of generic measures have been questioned for use in some conditions including dementia.[6] Patients with dementia can exhibit impairments of recall, time perception, insight, and expressive and receptive communication This means that patients with more severe symptoms may have particular difficulties in making selfreports of their own HRQL. COMPARISON OF GENERAL POPULATION, PATIENT, AND CARER UTILITY VALUES FOR DEMENTIA (self-reported DEMQOL and proxy [carer]–reported DEMQOL-Proxy) was developed and validated in a population with dementia and can be used together to measure the HRQL of patients with mild, moderate, and severe dementia.[7,8] DEMQOL-U and DEMQOL-Proxy-U are recently developed dementia-specific preference-based measures derived from DEMQOL and DEMQOL-Proxy These measures were valued by members of the UK general population and can be used to estimate QALYs for use in cost-utility analyses.[9,10,11]. Members of the general population and patients may differ in their sociodemographic characteristics, and this may affect how they value health states
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