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In the ever-evolving healthcare landscape, decision-makers rely on robust data and analytical tools to drive value-based care. Utilities – which are quantitative measures used to evaluate patient health outcomes – play a critical role in assessing the overall value of medical interventions.
By enabling patient preferences and quality of life measurements to be integrated into economic evaluations, utilities help to ensure that healthcare systems prioritize treatments that deliver meaningful benefits.
What are utilities?
Utilities can be defined as measures of the preference or value that an individual gives a particular health state. Utilities are usually expressed as a number between 0 (representing death) and 1 (representing perfect health)1, though extremely poor health states may be considered worse than death and therefore would be assigned a negative score.
Utility estimation consists of two main steps2:
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- The definition and description of a set of health states of interest.
- The valuation of those health states to provide a measurement of the strength of preference for each health state. Valuation is usually performed by patients with experience of the health state, or by members of the public asked to provide a hypothetical or societal value3.
Utilities can be estimated in one of two ways: directly or indirectly2. Direct measures of utility map preferences directly onto the utility scale, while indirect measures map preferences onto the utility scale indirectly via generic health-related quality of life questionnaires, for example the EQ-5D. Indirect measures are generally preferred as questionnaires are simple, require little explanation, and differentiate data into dimensions which direct methods do not register, such as mobility and pain.
Why are they important?
Utilities are typically combined with survival estimates to generate quality-adjusted life years (QALYs), which are measures of health that consider both quantity and quality of life gained. QALYs are particularly useful because they provide a standardized way to assess the benefits of healthcare interventions across different conditions.
As the use of economic evaluation for health technology assessment and market access decision making increases globally, QALYs are being increasingly utilized as a key outcome measure within these evaluations. In the UK, QALY calculations are a central part of the economic evaluation of pharmaceuticals submitted to NICE4, with the use of the EQ-5D within clinical trials being a preferred method for utility estimation.
Utilities serve as a cornerstone in health decision-making for several reasons.
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- Informing health policy and reimbursement: utility data is used to determine the cost-effectiveness of new treatments, and health agencies, including NICE, rely on QALYs to determine whether medical interventions provide value for money.
- Optimizing resource allocation: utilities help to prioritize interventions that deliver the most significant impact on patients’ well-being.
- Enhancing patient-centric care: utilities reflect patient preferences and experiences, making them essential for patient-centered decision making.
- Driving market access strategies: pharmaceutical companies use utility data to demonstrate product value to regulatory agencies and payers.
Challenges and future directions
Despite their importance, utilities are associated with several challenges, such as variability in measurement techniques, cultural differences in valuation, and the need for more patient-reported data. Digital tools allow the straightforward collection of invaluable real-time patient-reported utility data longitudinally across differing scenarios and various time points, providing deeper insights into patient preferences.
If you are interested in having a chat with one of our experts about how a utility generation study could support your product’s value, get in touch at info@vitaccess.com.
References
1. National Institute for Health and Care Excellence. Glossary. U. https://www.nice.org.uk/glossary?letter=u
2. Hayward Medical Communications. What are health utilities? (2014) https://www.nrc.gov/docs/ML2227/ML22275A007.pdf
3. Helgesson et al. Qual Life Res. 2020;29(6):1465-1482.
4. National Institute for Health and Care Excellence. Guide to the methods of technology appraisal (April 2013). http://publications.nice.org.uk/guide-to-the-methods-oftechnology-appraisal-2013-pmg9
5. Beresniak et al. J Rheumatol. 2007;34(11):2193-2200.
