Mean Time Trade-off Utility Research Articles

Elicitation of Health State Utility Values in Retinitis Pigmentosa by Time Trade-off in the United Kingdom.

Retinitis pigmentosa (RP) is an inherited retinal pathology associated with "night blindness" and progressive loss of peripheral vision, in some cases leading to complete blindness. Health state utility values are required for activities such as modelling disease burden or the cost-effectiveness of new interventions. The current study aimed to generate utility values for health states of varying levels of functional vision in RP, with members of the general public in the UK. Five health states were defined according to standard clinical measures of visual ability. Health state descriptions were developed following interviews with patients with RP in the UK (n=5). Further interviews were conducted for confirmation with healthcare professionals with specific experience of managing patients with RP in the UK (n=2). Interviews with members of the general public in the UK were conducted to value health states. A time trade-off (TTO) process based on the established Measurement and Valuation of Health (MVH) protocol was used. Due to the ongoing COVID-19 pandemic, all interviews were web-enabled and conducted 1:1 by a trained moderator. In total, n=110 TTO interviews were conducted with members of the UK general public. Mean TTO utility values followed the logical and expected order, with increasing visual impairment leading to decreased utility. Mean values varied between 0.78 ± 0.20 ("moderate impairment"), and 0.33 ± 0.26 ("hand motion" to "no light perception"). Supplementary visual analogue scale (VAS) scores also followed the logical and expected order: mean VAS values varied between 47.95 ± 15.38 ("moderate impairment") and 17.22 ± 12.49 in ("hand motion" to "no light perception"). These data suggest that individuals living with RP have substantially impaired quality of life. Utility values for RP have been elicited here using a method and sample that is suitable for economic modelling and health technology assessment purposes.

Development the societal preference-based utility value set for the Patient Health Questionnaire depression scale in Hungary

IntroductionDepression is associated with high impact on health-related quality of life (HRQoL). Health state valuations are used for cost-effectiveness analysis to provide results for health-policy interventions.ObjectivesThe study aims to estimate a population-based value set of depression described by Patient Health Questionnaire (PHQ-9). We intend to assess vignettes describing PHQ-9 health states to estimate utility valuesMethodsCurrent research elicited direct utility scores using time trade-off (TTO) method obtained from the Hungarian general population (N=2,000). TTO vignettes were created to describe hypothetical health states of depression based on the nine items of PHQ-9. The hypothetical health states were sorted orthogonally in 11 blocks, each containing 4 vignettes (combinations of no; mild; moderate; severe depression). All respondents valued the four health states of one randomly given block. Conventional TTO method was applied, using a 10-year timeframe, while the first iteration step was randomized to 1,3 and 5 year. Preference weights were estimated using regression model fitted to TTO utility results.ResultsAltogether 1,999 respondents valued overall 34 different health states. The mean age was 47.3 (16.9) years, the majority was female (57.2%). Nearly half of the respondents were secondary educated 45.4%, 27.3% higher educated and 27.2% completed primary school. The mean TTO utility of selected mild, moderate and severe depression was: 0.83; 0.82 and 0.77 respectively.ConclusionsOur results constitute the first population-based value set for PHQ-9. Utility scores give useful information for cost-effectiveness assessments. Estimates provide preference-based quality of life weights for the Hungarian population.DisclosureNo significant relationships.

Estimation of Health-State Utility Values and Factors Driving Health-Related Quality of Life in People Living with HIV and AIDS and Receiving cART in Germany: Baseline Analysis of a Cohort Study

HIV has become a chronic disease since widespread of combined antiretroviral therapy (cART). Understanding the influence of therapeutic and preventive interventions on health-related quality of life (HRQoL) of people living with HIV and AIDS (PLWHA) is important. Information about health state utilities and HRQoL in PLWHA after the introduction of cART is limited, especially in Germany. The study aims to estimate and describe health state utilities and HRQoL in PLWHA in Germany and explore the effects of patient characteristics, clinical and treatment factors. Utilities and HRQoL in PLWHA in Germany were measured with the generic EQ-5D-3L questionnaire. Health state utilities were calculated based on the EQ-5D descriptive system using the German EQ-5D-3L time trade-off (TTO) value set. HRQoL was calculated based on the EQ visual analogue scale (EQ-VAS). Extensive descriptive analyses were performed to represent utility values for different groups of the patients. Generalized linear models (GLMs) with beta-inflated distributions were used to determine patient characteristics and clinical factors that influence TTO utilities and VAS scores. 1056 PLWHA completed the EQ-5D-3L questionnaires at the beginning of the study. The mean TTO utility value is 0.912 (SD ± 0.154), and the mean VAS HRQoL is 84.32 (SD ± 18.55). “Anxiety/depression” and “pain/physical discomfort” are the most affected dimensions. A longer period of living with HIV, a lower CD4-cell count, having symptomatic HIV or AIDS and an increased number of changes in therapy are associated with decreased utilities and a lower probability of having HRQoL of perfect health. No significant effect of duration of regimen was found. Depression significantly decreases TTO utility values. Higher education, full-time employment and female gender are associated with higher utilities. The resulted EQ-VAS values for PLWHA in Germany are comparable with EQ-VAS estimates for the general population. The obtained estimates can be used as inputs for health economic evaluations of HIV-interventions. Addressing anxiety and depression may reduce the quality of life impairment in PLWHA. Impact of comorbidities needs further investigation.

Health care stakeholder perceptions of vision loss

Perceptions of the quality of life (QOL) associated with vision loss vary widely. Herein, we consider the perceptions of patients with vision loss as the criterion for QOL quantification associated with vision loss. With the QOL instrument, time tradeoff utility analysis, the upper anchor of 1.00 is associated with permanent normal vision, whereas the lower anchor of 0.00 is associated with death. A time tradeoff utility of 0.26 is associated with no light perception bilaterally. Patients with legal blindness in the US (≤20/200 vision bilaterally) have a mean time tradeoff utility of 0.47. The general public, however, associates legal blindness with a time tradeoff utility of 0.86. Thus, legally blind patients consider their QOL loss from blindness to be 279% (1.00-0.47/1.00-0.86) worse than does the American public. Public estimates of the QOL loss from blindness (utility = 0.86) suggest it is less debilitating than patient QOL estimates for migraine headaches (utility = 0.83). The mean medical student blindness utility estimate is 0.86, whereas that for non-ophthalmic physicians is 0.82. Ophthalmologists underestimated the QOL associated with vision loss in macular degeneration patients by 96%-750%. Underestimating the QOL loss from blindness likely diminishes the perceived benefit of blindness interventions. Minimization of interventional benefit by underestimating patient impairment from vision loss could lead to adverse consequences for patients with vision loss, for vision research, for and those who treat vision loss.

Health-related quality of life in patients with uveitis

Background/aimsTo measure health-related quality of life (HRQOL) in patients with uveitis using time trade-off (TTO) and standard gamble (SG) methods of direct utility analysis.MethodsConsecutive patients attending a tertiary referral uveitis...

Challenges Associated with Estimating Utility in Wet Age-Related Macular Degeneration: A Novel Regression Analysis to Capture the Bilateral Nature of the Disease.

IntroductionThe estimation of utility values for the economic evaluation of therapies for wet age-related macular degeneration (AMD) is a particular challenge. Previous economic models in wet AMD have been criticized for failing to capture the bilateral nature of wet AMD by modelling visual acuity (VA) and utility values associated with the better-seeing eye only.MethodsHere we present a de novo regression analysis using generalized estimating equations (GEE) applied to a previous dataset of time trade-off (TTO)-derived utility values from a sample of the UK population that wore contact lenses to simulate visual deterioration in wet AMD. This analysis allows utility values to be estimated as a function of VA in both the better-seeing eye (BSE) and worse-seeing eye (WSE).ResultsVAs in both the BSE and WSE were found to be statistically significant (p < 0.05) when regressed separately. When included without an interaction term, only the coefficient for VA in the BSE was significant (p = 0.04), but when an interaction term between VA in the BSE and WSE was included, only the constant term (mean TTO utility value) was significant, potentially a result of the collinearity between the VA of the two eyes. The lack of both formal model fit statistics from the GEE approach and theoretical knowledge to support the superiority of one model over another make it difficult to select the best model.ConclusionLimitations of this analysis arise from the potential influence of collinearity between the VA of both eyes, and the use of contact lenses to reflect VA states to obtain the original dataset. Whilst further research is required to elicit more accurate utility values for wet AMD, this novel regression analysis provides a possible source of utility values to allow future economic models to capture the quality of life impact of changes in VA in both eyes.FundingNovartis Pharmaceuticals UK Limited.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0620-x) contains supplementary material, which is available to authorized users.

Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration.

BackgroundUtility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3–3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational case–control study aimed to measure loss of utility in patients with amblyopia with recent decrease of vision in their better eye. As these patients are rare, the sample was supplemented by patients with bilateral age-related macular degeneration with similar decrease of vision.MethodsFrom our out-patient department, two groups of patients with recent deterioration to bilateral visual acuity less than Snellen 0.5 (bilateral visual impairment, BVI) were recruited, with either persistent amblyopia and age-related macular degeneration (AMB + AMD), or with bilateral age-related macular degeneration (BAMD). To measure utility, the time trade-off method and the standard gamble method were applied through interviews. Correlations were sought between utility values and visual acuity, age and Visual Function Questionnaire-25 scores.ResultsSeventeen AMB + AMD patients (mean age 72.9 years), and 63 BAMD patients (mean age 79.6 years) were included in the study. Among AMB + AMD, 80 % were willing to trade lifetime in exchange for cure. The overall mean time trade-off utility was 0.925. Among BAMD, 75 % were willing to trade, utility was 0.917. Among AMB + AMD, 38 % accepted risk of death in exchange for cure, overall mean standard gamble utility was 0.999. Among BAMD, 49 % accepted risk of death, utility was 0.998. Utility was not related to visual acuity but it was to age (p = 0.02).ConclusionElderly patients with BVI, caused by persistent amblyopia and age-related macular degeneration (AMD) or by bilateral AMD, had an approximately 8 % loss of TTO utility. Notably, the 8 % loss in elderly with BVI differs little from the 3.7 % loss we found previously in 35-year-old persons with unilateral amblyopia with good vision in the other eye. The moderate impact of BVI in senescence could be explained by adaptation, comorbidity, avoidance of risk and a changed percept of cure.

Utility elicitation study in the UK general public for late-stage chronic lymphocytic leukaemia

In the United Kingdom (UK), chronic lymphocytic leukaemia (CLL) makes up 40 % of all leukaemias in patients over 65 years. The study objective was to obtain societal preferences in the UK for "progression-free" and "progressive" states of late-stage CLL, refractory to current first and second line regimens. Preferences were also obtained for selected treatment-related adverse events (AEs). A utility elicitation study, using the time trade-off (TTO) method, was conducted by face-to-face interviews with 110 subjects for a baseline disease state (before treatment), three primary disease states [progression-free survival (PFS) and treatment responder, PFS and treatment non-responder and disease progression], and 4 AE sub-states (PFS responder with thrombocytopenia, neutropenia, and infection, and PFS non-responder with infection). TTO scores were converted into utility values, and disutilities were calculated for AEs. Visual analogue scale (VAS) scores were obtained. The primary disease state mean TTO utility scores were: baseline: 0.549; PFS response: 0.671; PFS non-response: 0.394; and progression: 0.214. The mean TTO utility (disutility) scores for the AEs were: PFS response with thrombocytopenia, 0.563 (-0.108), neutropenia, 0.508 (-0.163), and infection, 0.476 (-0.195); PFS non-response with infection, 0.333 (-0.061). The VAS results were in line with the TTO results. The utility was higher for the PFS state than baseline, but decreased below baseline in non-response and disease progression states. AEs had an impact on utility within the PFS response state. The severe infection AE had a greater impact on utilities for the responding to treatment state compared to the non-responder state.

Health state utilities for skeletal-related events associated with bone metastases.

e16620 Background: Patients with solid tumors and bone metastases often experience skeletal-related events (SREs) and pain. Although cost-utility models are often used to estimate treatment outcomes for metastatic cancer, limited information is available on utilities of SREs. The purpose of this study was to estimate the disutility of 4 SREs represented by 8 health states (HS): spinal cord compression (2 HS: with and without paralysis), pathological fracture (3 HS: leg, rib, arm), radiation (2 HS: administered in 2 appointments and administered daily for 2 weeks), and surgery performed to stabilize a bone. Methods: Participants from the UK general population completed time trade-off (TTO) interviews to assess the utility of hypothetical health state vignettes describing cancer with bone metastases and SREs. The TTO task involved rating a 2-year lifespan with cancer and bone metastases. Then, the SREs were each added to this basic health state. Changes in Quality of Life Years (QALYs) were computed to estimate the decrement associated with each year in which an SRE occurs. Results: A total of 126 participants completed interviews (51.6% male, 85.7% white). Cancer with bone metastases without an SRE had a mean TTO utility score of 0.47 (SD = 0.42) on a standard utility scale (1 = full health and 0 = death). Of the SREs, spinal cord compression was associated with the greatest QALY reduction: 0.68 with paralysis and 0.44 without paralysis. Surgery was associated with a QALY reduction of 0.14, while the three fractures had a mean QALY reduction of 0.07. Two weeks and two appointments of radiation treatment had QALY reductions of 0.10 and 0.05, respectively. Conclusions: All SREs were associated with a reduction in QALYs, suggesting a substantial decrease in quality of life beyond the impact of cancer with bone metastases. The resulting QALYs may be used in cost-utility models examining the value of treatments for SREs associated with bone metastases.

A prospective cohort study defining utilities using time trade‐offs and the Euroqol‐5D to assess the impact of cancer‐related lymphedema

The devastating impact of lymphedema on cancer survivors' quality of life has prompted consideration of several changes in medical and surgical care. Unfortunately, our understanding of the benefits gained from these approaches relative to their cost remains limited. This study was designed to estimate utilities for lymphedema and characterize how utilities differ between subgroups defined by lymphedema etiology and distribution. A consecutive sample of 236 subjects with lymphedema seen at a lymphedema clinic completed both a time trade-off (TTO) exercise and the Euroqol 5D. Responses were adjusted in multivariate regression models for demographic factors, comorbidities, and lymphedema severity/location. Most participants (167 of 236, 71%) had lymphedema as a consequence of cancer treatment; 123 with breast cancer and upper extremity involvement. Mean TTO utility estimates were consistently higher than Euroqol 5D estimates. Unadjusted TTO (0.85; standard deviation [SD], 0.21) and Euroqol 5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and patient body mass index (BMI). Adjusted utility scores were lowest in patients with cancer-related lower extremity lymphedema (TTO=0.82; SD, 0.04 and Euroqol 5D=0.80; SD, 0.03). Breast cancer patients also had lower adjusted Euroqol 5D scores (0.80; SD, 0.02). Lymphedema-associated utilities are in the range of 0.80. Lower utilities are observed for patients with higher lymphedema stages, elevated BMI, and cancer-related lymphedema. Greater expenditures for the prevention and treatment of cancer-related lymphedema are warranted.

Eliciting health state utilities from the general public for severe chronic pain

There is an absence of data on public preferences for health states (HSs) associated with severe chronic pain. The aim of this study was to develop accurate HS descriptions for severe chronic pain requiring intrathecal (IT) therapy and to derive utility weights that describe the health-related quality of life (HRQL) impact of chronic pain associated with malignant (MP) and non-malignant (NMP) aetiologies. Eight visual analogue scale pain index (VAS-PI) HSs were defined using ranges 0-40, 41-60, 61-80 and 81-100 applied to both MP and NMP. Additionally, eight HSs representing common adverse events associated with IT therapy were identified. The content and description of the HSs were ascertained by interviews with five United Kingdom clinical experts. In total, 16 HSs were compiled. These HS descriptions and HS questionnaires were administered to 102 members of the public, utilising a time trade off (TTO) approach to estimate utilities for the HSs. Participants generally were well matched to the general public in England and Wales, with some differences in mean age, race and education. A substantial decline in utility was observed with more severe VAS-PI values. The mean TTO utility values also decreased from mild pain to severe pain. Participants were able to differentiate between the side effects. The study shows a clear decrement in utility moving from different severity levels of severe chronic pain.

Utility Assessment in Patients with Mental Disorders

Preference-based health-state values, also referred to as utility scores, are considered an important measure of outcome in the evaluation of healthcare. A common approach to elicit utility scores is the use of the time trade-off (TTO) method; however, the data on TTO utility scores in patients with mental disorders are scarce. To analyse the TTO method in patients with mental disorders in terms of discriminative ability, validity and the refusal to trade life time (zero trade). In patients with affective (n = 172), schizophrenia spectrum (n = 166) and alcohol-related (n = 160) mental disorders, TTO utilities were administered through a standardized interview. Measures of quality of life (QOL) EQ-5D, WHOQOL-BREF, subjective (SCL-90R) and objective (CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of TTO utilities. Validity was analysed by assessing the correlation of TTO utilities with all other scores. The association of a patient's QOL, sociodemographic and disease-related variables with zero trade was analysed by logistic regression. Of patients with affective/schizophrenic/alcohol-related mental disorders, 153/143/145 (89/86/91%), respectively, completed the TTO elicitation; 29/43/28% of the respondents were zero traders. The mean TTO utility was 0.66/0.75/0.61 and the median was 0.85/0.95/0.75. TTO utility scores discriminated well among more impaired mental health states, but discrimination was limited among less impaired health states. In patients with affective and alcohol-related mental disorders, TTO utility scores were significantly correlated (mostly moderate: 0.3 < r < 0.5) with all other scores. However, in schizophrenic patients, TTO utility scores were only a little correlated with other subjective measures and not correlated with objective measures. QOL was significantly associated with zero trade; the influence of the other variables on zero trade was negligible. TTO utility scores in patients with affective or alcohol-related mental disorders were reasonably valid, but discriminative ability was compromised by a ceiling effect due to zero trade. In schizophrenic patients, validity of TTO utility scores was not demonstrated.

Utility assessment among patients of primary angle closure/glaucoma in China: a preliminary study

Aim:To evaluate utility values among patients of primary angle closure/glaucoma (PAC/G) in a local hospital in China, and the factors influencing the quality of their lives.Methods:A cross-sectional study. Utility values...

Quality of life after postoperative endophthalmitis

The aim of this study is to determine if postoperative endophthalmitis adversely affects quality of life after cataract surgery. We compared quality of life in patients who developed endophthalmitis after cataract surgery between 1 January and 31 December 2003 with those who had uncomplicated surgery. The National Eye Institute VFQ-25 (VFQ-25) and EuroQol EQ-5D (EQ-5D) questionnaires and time trade-off utility scores were used to compare self-perceived general health and vision-related quality of life between groups. Linear regression was used to model differences between groups after adjusting for age, gender and visual acuity in the better eye. Nineteen postoperative endophthalmitis cases were compared with 30 who had uncomplicated cataract surgery. Following surgery the mean composite VFQ-25 score was 13.5% (95% confidence interval [CI]: 6.0-26.4, P < 0.01) lower in endophthalmitis cases. Endophthalmitis patients reported significantly lower (P < 0.05) general vision, near vision, peripheral vision, mental health and role difficulties subscales scores after adjusting for age, sex and visual acuity. No significant differences were found in other subscales. Mean time trade-off utility and all EQ-5D scores were similar except for mobility (95% CI: 0.04-0.68, P < 0.05). Endophthalmitis after cataract surgery negatively impacts on self-perceived vision-related quality of life, resulting in poorer psychological well-being and ability to maintain a role in daily life.

Utility Values in Singapore Chinese Adults With Primary Open-Angle and Primary Angle-Closure Glaucoma

To evaluate utility values in Chinese glaucoma patients. Singapore Chinese residents (n = 213) with primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a single tertiary ophthalmic center. Standard face-to-face interviews were conducted to ask about utility values (time trade-off and standard gamble for both death and blindness). Ocular information, including current visual acuity, intraocular pressure, visual field defect, and cup-disc ratio were also obtained. The mean time trade-off utility value was 0.88 (95% confidence interval 0.85, 0.91), and standard gamble for death and blindness were 0.94 (95% confidence interval 0.93, 0.96) and 0.95 (95% confidence interval 0.93, 0.97), respectively. Only 35.7% of patients were willing to trade time, and 34.3% willing to risk blindness in return for perfect vision. Both primary angle-closure glaucoma and primary open-angle glaucoma patients had similar utility values. After adjusting for age, gender, language spoken, educational level, and diagnosis, patients with better eye visual field PSD > 10 were 2.52 times (95% confidence interval 1.13, 5.61) more willing to trade time. In a multivariate model, the odds ratio of willingness to risk blindness for a complete hypothetical glaucoma cure was 9.88 (95% confidence interval 1.65, 59.23) for patients who had only visited an ophthalmologist 15 years or more ago, and 0.53 (95% confidence interval 0.27, 1.02) for patients who had previous trabeculectomy. Most Chinese glaucoma patients in Singapore are not willing to trade time or risk blindness. Patients with worse visual fields in the better-seeing eye are more willing to trade time; whereas patients who have not seen an ophthalmologist for at least 15 years or who had no history of a previous trabeculectomy are more willing to risk blindness.

Health values of adolescents with cystic fibrosis

Objectives To assess health values (utilities) in adolescents with cystic fibrosis (CF) and to evaluate how health status and clinical factors affect their health values. Methods Adolescents 12 to 18 years of age completed the Child Health Questionnaire (CHQ), Health Utilities Index Mark 2 (HUI2), and 3 health value measures: the visual analog scale (VAS), time tradeoff (TTO), and standard gamble (SG). Severity of illness was measured by percent of predicted forced expiratory volume in 1 second (FEV1) and frequency of pulmonary exacerbations. Results The mean age (± SD) of the 65 adolescents was 15.1 (± 2.1) years; 53.8% were male; their mean FEV1 was 72.8% (± 27.0%) predicted. The mean TTO utility was 0.96 (± 0.07) and the mean SG utility was 0.92 (± 0.15). In multivariable analysis, the General Health Perceptions domain from the CHQ was the only health status scale significantly associated with the VAS, TTO, and SG. No clinical or demographic measures were significantly related to both TTO and SG scores. Conclusions Direct utility assessment in adolescents with CF is feasible. Their TTO and SG utilities are generally high, indicating that they are willing to trade very little of their life expectancy or take more than a small risk of death to obtain perfect health. Their self-rated health perceptions are related to their health values, but, as in adult populations, only moderately so, indicating that health values are highly individualistic. Therefore, health values should be ascertained directly from adolescents. (J Pediatr 2003;142:133-40)

Utility values associated with blindness in an adult population

AIMTo ascertain utility values associated with varying degrees of legal blindness.METHODSA cross sectional study on three group of patients. There were: (1) 15 patients with complete absence of vision (no...

Health values of the seriously ill. SUPPORT investigators.

To assess 1) the health values and health ratings of seriously ill hospitalized patients, their surrogate decision makers, and their physicians; 2) the determinants of health values; and 3) whether health values change over time. Prospective, longitudinal, multicenter study. 5 academic medical centers. 1438 seriously ill patients with at least one of nine diseases who had a projected overall 6-month mortality rate of 50%; their surrogates; and their physicians. Time-tradeoff utilities (reflecting preferences for a shorter but healthy life) and health ratings. At study day 3, patients had a mean time-tradeoff utility of 0.73 +/- 0.32 (median [25th, 75th percentile], 0.92 [0.63, 1.0]), indicating that they equated living 1 year in their current state of health with living 8.8 months in excellent health. However, scores varied widely; 34.8% of patients were unwilling to exchange any time in their current state of health for a shorter life in excellent health (utility, 1.0), and 9.0% were willing to live 2 weeks or less in excellent health rather than 1 year in their current state of health (utility, 0.04). Health rating scores averaged 57.8 +/- 24.0 (median [25th percentile, 75th percentile], 60 [50, 75]) on a scale of 0 (death) to 100 (perfect health). The patients' mean time-tradeoff score exceeded that of their paired surrogates (n = 1041) by 0.08 (P < 0.0001). Time-tradeoff scores were related to psychosocial well-being; health ratings; desire for resuscitation and extension of life rather than relief of pain and discomfort; degree of willingness to live with constant pain; and perceived prognosis for survival and independent functioning. Scores of surviving patients increased by an average of 0.06 after 2 months (P < 0.0001) and 0.08 after 6 months (P < 0.0001). Health values of seriously ill patients vary widely, are higher than patients' surrogates believe, are related to few other preference and health status measures, and increase over time.