Here we offer insights into selected scientific projects at the Institute.
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The Multi-Instrument Comparison (MIC) Project:
A Cross National Comparison of Eight Generic Quality of Life Instruments
Health economists are used to conceptualize value in terms of “utility.” Consequently, a routinely applied approach to measure the “value” of medical interventions has been to determine health gains in terms of length of life and health-related quality of life, the latter being “valued” on the grounds of individual preferences for (as a proxy of the utility of) being in a given health state.
The direct measurement of preferences for health states can be a cumbersome task, being both complex, time consuming and susceptible to various sources of (unintended or even provoked) bias. An attractive and widely used alternative is to resort to one of the validated multi-attribute health status classification systems. These are the American Quality of Well Being (QWB) scale, the Canadian Health Utilities Index (HUI), the European EQ-5D and SF-6D instruments, the Australian Assessment of Quality of Life (AQoL) and the Finnish 15D system. Each of these instruments can be used to derive a “utility index” required to calculate quality-adjusted life years (QALYs), a commonly used metric for health-related outcomes in cost effectiveness analysis.
A fundamental problem with this approach is that different multi-attribute utility (MAU) instruments produce different numbers from the same individual. Following prior research (arguably, the most comprehensive surveys to date have been G. Hawthorne & J. Richardson, 2001, and D.G. Fryback et al., 2010), the proportion of variance in one instrument explained by another instrument (R2) is between a meagre 0.47 and 0.56 on average. This raises the important questions of (1) why this does occur and (2) which instrument is most appropriate in a particular context. The situation is further complicated by the fact that, in contrast to mainstream health economists’ focus on utility (i.e., the strength of a person’s preferences), psychologists tend to equate “value” with well-being or happiness. Yet another approach is to focus on a person’s basic capabilities (i.e., what an individual can achieve or experience, instead of what the individual actually does accomplish or experience).
Therefore the Multi-Instrument Comparison (MIC) Project was initiated by a group of health economists under the lead of Jeff Richardson from the Centre of Health Economics (CHE) at Monash University, Melbourne / Victoria (Australia). The objectives of the MIC Study are to further explore and document the differences between the various classification systems and to provide assistance in answering the question of which instrument should be chosen in a given context. In addition to five MAU instruments, subjective well-being (using the PWI, IHS, and SWLS scales) and non-utility measures (the SF-36, self-administered TTO, and IECAP-A instruments) were administered in the study. InnoValHC has been responsible for the German branch of the MIC Study, with Michael Schlander being one of the chief investigators for the project (alongside Robert Cummins from Deakin University in Melbourne / Victoria (Australia), Robert Kaplan from the University of California at Los Angeles / California (USA), Jan Abel Olsen from the University of Tromso / Norway, and Joanna Coast from the University of Birmingham / England) supporting the team at Monash University. The project has been generously funded by the Australian National Health and Medical Research Council (NHMRC; project grant ID 1006334).
First findings from Germany were presented to the 16th Annual European Congress of the International Society for Pharmacoeconomics & Outcomes Research (ISPOR) in Dublin / Ireland, November 2-6, 2013 (cf. also Publications):
Abstract (96.2 KiB)
Presentation (460.0 KiB)