Preference-based scores summarize multiple domains of health into a single score anchored at 0 (as bad as dead) and 1 (perfect or ideal health). They are useful for prioritizing the effects of interventions in cost-utility analyses.
The HU instrument used most commonly is the EQ-5D, a self-completion questionnaire that asks respondents to classify their prevailing health state and evaluate it using a visual analog scale (VAS). However, in some samples of head and neck cancer patients, the EQ-5D health state descriptions were found to be coarse, and the resulting VAS scores exhibited poor face validity. In addition, some socio-demographic factors, including age and educational attainment, were found to influence both EQ-5D health state classification and the valuation of those health states, and these influences may have contributed to differences in HU instrument estimates.
One strategy for improving the accuracy of HU instruments is to develop global measures that incorporate information from multiple domains in a single measure. For example, the PROMIS-Preference (PROPr) score, which combines a health state profile derived from a set of questions about fatigue, pain, sleep disturbance, and ability to participate in social roles and activities with a SF-36 mental health scale, has been shown to have good psychometric properties compared with other, more domain-specific instruments in a variety of settings, including in head and neck cancer patients. However, it is important to note that these global measures only provide a good comparison of large groups and may not be particularly helpful in guiding clinical decisions for individual patients. health state score
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