Health Utilities Index

Health Utilities Index (HUI) is a family of generic health profiles and preference-based systems for the purposes of measuring health status, reporting health-related quality of life (HRQL), and producing utility scores. HRQL, as defined by Patrick and Erickson, "is the value assigned to duration of life as modified by the impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy". HUI questionnaires, designed to elicit responses from a wide variety of subjects, make it easy to incorporate such a patient-reported outcome (PRO) and utility instrument into a clinical study.

HUI evolved in response to the need for a standardized system to measure health status and HRQL to describe: 1) the experience of patients undergoing therapy; 2) long-term outcomes associated with disease or therapy; 3) the efficacy, effectiveness and efficiency of healthcare interventions; and 4) the health status of general populations.

HUI currently consists of two systems, HUI2 and HUI3, which together describe almost 1,000,000 unique health states. Each of HUI2 and HUI3 includes a generic comprehensive health status classification (i.e., profile) system and a generic HRQL utility scoring system. For most applications, HUI3 should be specified as the measure for primary analyses. It has the more detailed descriptive system of the two systems, full structural independence, and population norms available. HUI2 does offer distinct, independent attributes including self-care (for use with nursing home populations for example), emotion that focuses on worry/anxiety, and fertility. The two systems are independent but complementary, adding valuable information at low cost and with the HUI2 providing an efficient source of data for secondary/sensitivity analyses.

The HRQL scoring systems provide utility (preference) scores on a generic scale where dead = 0.00 and perfect health = 1.00. HUI scores meet or exceed the criteria for calculating quality-adjusted life years (QALY), and the requirements of published guidelines for economic evaluations of pharmaceutical and other health care services. The health status classification and HRQL scoring systems are generic in terms of applying to all people age 5 years and older in both clinical and general populations. A health-status classification system based on HUI2 and HUI3 suitable for children 3 to 5 years of age is under development.

HUI has been used in hundreds of clinical studies covering a wide variety of health problems and in numerous large general population surveys since 1990. There is a growing trend for the use of HUI as a primary health outcome measure in the form of QALYs.

HUI measures have strong theoretical foundations, are valid, are reliable, and are well accepted by patients and professionals.

HUI is a registered trademark of Health Utilities Inc., 88 Sydenham Street, Dundas, ON, L9H 2V3, Canada.

Abbreviated Name: HUI

Author(s): Furlong W, Feeny D, Torrance GW

Purpose: To describe health status, measure within-attribute morbidity and health-related quality of life, and produce utility scores Population: All

Age Range : 5 to unlimited years, inclusive.

Type of Instrument: Utility, Disability/Physical Functioning, Economics, Quality of life Mode of Administration:

Self-/ Interviewer/ Telephone/ Caregiver- and Proxy-administered Self-administered versions: 6 to 10 minutes (mean= 8 minutes) Interviewer-administered versions: 3 to 6 minutes (mean= 4 minutes) Yes/no -descriptive phrases of levels from HUI health status classification systems Global score Scores by dimension Higher scores show better QoL Yes


Time required: Response Options: Scoring:

Score Direction: Weighting:

Number of Items:

Self-administered formats : 15-item multiple-choice questionnaires. Interviewer-administered formats : 40-item skip-pattern questionnaires Original Language: English

Existing Translations : French, Chinese (Simplified), Chinese (Traditional), Dutch, German, Italian, Portuguese, Spanish, Swedish, Japanese, Danish, Finnish, Czechoslovakian, Norwegian and Russian.

Copyright: HUI&HUI-Health Utilities Index are registered trademarks of Health Utilities Inc.

Contact for information and permission to use:

William (Bill) Furlong Health Utilities Inc. 88 Sydenham Street Dundas ON L9H 2V3 Canada

Telephone: (905) 525-9140 extension 22389 FAX: (905) 627-7914

Dimensions covered by the questionnaire :

- Sensation (4 levels)

- Mobility (5 levels)

- Emotion (5 levels)

- Cognition (4 levels)

- Fertility (3 levels)

- Hearing (6 levels)

- Ambulation (6 levels)

- Dexterity (6 levels)

- Emotion (5 levels)

- Cognition (6 levels)

Key References:

1. Feeny D, Furlong W, Torrance GW et al. Multiattribute and single-attribute utility functions for the Health Utilities Index Mark 3 System. Medical Care 2002;40(2):113-128.

Background: The Health Utilities Index Mark 3 (HUI3) is a generic multiattribute preference-based measure of health status and health-related quality of life that is widely used as an outcome measure in clinical studies, in population health surveys, in the estimation of quality-adjusted life years, and in economic evaluations. HUI3 consists of eight attributes (or dimensions) of health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain with 5 or 6 levels per attribute, varying from highly impaired to normal. Objectives: The objectives are to present a multiattribute utility function and eight single-attribute utility functions for the HUI3 system based on community preferences. Study Design: Two preference surveys were conducted. One, the modeling survey, collected preference scores for the estimation of the utility functions. The other, the direct survey, provided independent scores to assess the predictive validity of the utility functions. Measures: Preference measures included value scores obtained on the Feeling Thermometer and standard gamble utility scores obtained using the Chance Board. Respondents: A random sample of the general population (> or =16 years of age) in Hamilton, Ontario, Canada. Results: Estimates were obtained for eight single-attribute utility functions and an overall multiattribute utility function. The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88. Conclusions: The HUI3 scoring function has strong theoretical and empirical foundations. It performs well in predicting directly measured scores. The HUI3 system provides a practical way to obtain utility scores based on community preferences.

2. Furlong W, Feeny D, Torrance GW, Barr RD. The Health Utilities Index system for assessing health-related quality of life in clinical studies. Annals of Medicine 2001;33:375-384.

This paper reviews the Health Utilities Index (HUI) systems as means to describe health status and obtain utility scores reflecting health-related quality of life (HRQoL). The HUI Mark 2 (HUI2) and Mark 3 (HUI3) classification and scoring systems are described. The methods used to estimate multiattribute utility functions for HUI2 and HUI3 are reviewed. The use of HUI in clinical studies for a wide variety of conditions in a large number of countries is illustrated. HUI provides a comprehensive description of the health status of subjects in clinical studies. HUI has been shown to be a reliable, responsive and valid measure in a wide variety of clinical studies. Utility scores provide an overall assessment of the HRQoL of patients. Utility scores are also useful in cost-utility analyses and related studies. General population norm data are available. The widespread use of HUI facilitates the interpretation of results and permits comparisons. HUI is a useful tool for assessing health status and HRQoL in clinical studies.

3. Feeny DH, Furlong W, Boyle M, Torrance GW. Health Utilities Index. In : Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd Edition. Philadelphia : Lipponcott-Raven Press ; 1996 :85-95.

4. Torrance GW, Feeny DH, Furlong WJ et al. Multi-attribute preference functions for a comprehensive health status classification system : Health Utilities Index Mark 2. Medical Care 1996;34:702-722.

The Health Utilities Index Mark 2 (HUI:2) is a generic multiattribute, preference-based system for assessing health-related quality of life. Health Utilities Index Mark 2 consists of two components: a seven-attribute health status classification system and a scoring formula. The seven attributes are sensation, mobility, emotion, cognition, self-care, pain, and fertility. A random sample of general population parents were interviewed to determine cardinal preferences for the health states in the system. The health states were defined as lasting for a 60-year lifetime, starting at age 10. Values were measured using visual analogue scaling. Utilities were measured using a standard gamble technique. A scoring formula is provided, based on a multiplicative multiattribute utility function from the responses of 194 subjects. The utility scores are death-anchored (death = 0.0) and form an interval scale. Health Utilities Index Mark 2 and its utility scores can be useful to other researchers in a wide variety of settings who wish to document health status and assign preference scores.

5. Feeny D, Furlong W, Boyle M, Torrance GW. Multiattribute health status classification systems: Health Utilities Index.. Pharmacoeconomics 1995:7:490-502.

In this article, multi-attribute approaches to the assessment of health status are reviewed with a special focus on 2 recently developed systems, the Health Utilities Index (HUI) Mark II and Mark III systems. The Mark II system consists of 7 attributes: sensation, mobility, emotion, cognition, self-care, pain and fertility. The Mark III system contains 8 attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain. Each attribute consists of multiple levels of functioning. A combination of levels across the attributes constitutes a health state. The HUI systems are deliberately focused on the fundamental core attributes of health status, and on the capacity of individuals to function with respect to these attributes. Thus, the measure obtained constitutes a pure description of health status, uncontaminated by differential opportunity or preference. Multi-attribute systems provide a compact but comprehensive framework for describing health status for use in population health and programme evaluation studies. An important advantage of such systems is their ability to simultaneously provide detail on an attribute-by-attribute basis and to capture combinations of deficits among attributes. An additional advantage is their compatibility with multi-attribute preference functions, which provide a method for computing a summary health-related quality-of-life score for each health state.

6. Torrance GW, Furlong W, Feeny D et al. Multi-attribute preference functions : Health Utilities Index. Pharmacoeconomics 1995;7:503-520.

Multi-attribute utility theory, an extension of conventional utility theory, can be applied to model preference scores for health states defined by multi-attribute health status classification systems. The type of preference independence among the attributes determines the type of preference function required: additive, multiplicative or multilinear. In addition, the type of measurement instrument used determines the type of preference score obtained: value or utility. Multi-attribute utility theory has been applied to 2 recently developed multi-attribute health status classification systems, the Health Utilities Index (HUI) Mark II and Mark III systems. Results are presented for the Mark II system, and ongoing research is described for the Mark III system. The theory is also discussed in the context of other well known multi-attribute systems. The HUI system is an efficient method of determining a general public-based utility score for a specified health outcome or for the health status of an individual. In clinical populations, the scores can be used to provide a single summary measure of health-related quality of life. In cost-utility analyses, the scores can be used as quality weights for calculating quality-adjusted life years. In general populations, the measure can be used as quality weights for determining population health expectancy.

7. David Feeny, William Furlong and George W. Torrance. The Health Utilities Index: An Update. Quality of Life Newsletter 1999;22:8-9

As many readers of Quality of Life Newsletter know the Health Utilities Index (HUI) is a family of generic health status and health-related quality of life (HRQL) measures. The family of measures includes the Health Utilities Index Mark 1 (HUI1), Mark 2 (HUI2), and Mark 3 (HUI3) systems. Each HUI measure includes a health-status classification system and a preference-based scoring formula. Although HUI1 is still used, HUI2 and HUI3 are much more frequently used both in clinical and population health studies and will be the focus of this note.

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