Estimating Preference-Based Health Utilities Index Mark 3 Utility Scores for Childhood Conditions in England and Scotland

National Perinatal Epidemiology Unit, University of Oxford, Headington, Oxford, England.
Medical Decision Making (Impact Factor: 3.24). 04/2009; 29(3):291-303. DOI: 10.1177/0272989X08327398
Source: PubMed


A common feature of studies that have compiled lists or catalogues of preference-based health-related quality-of-life weights for inclusion within quality-adjusted life years (QALYs) is their focus upon adult populations.More generally, utility measurement in or on behalf of children has been constrained by a number of methodological concerns.
To augment previous catalogues of preference-based health-related quality-of-life weights by estimating preference-based Health Utilities Index Mark 3 (HUI3) multiattribute utility scores associated with a wide range of childhood conditions.
Data for 2236 children from the "Disability Survey 2000: Survey of Young People With a Disability and Sport" formed the basis of this investigation. Ordinary least squares (OLS), Tobit, and censored least absolute deviations(CLAD) regression methods were used to estimate adjusted marginal disutilities for each condition from 2 thresholds: 1) a threshold of 1.0 representing perfect health and 2) a normative childhood utility threshold.
Prespecified statistical tests indicated a preference for the OLS regression model over the Tobit and CLAD models. The unadjusted mean, median, 25th percentile and 75th percentile HUI3 multiattribute utility scores and adjusted marginal disutilities are presented for 43 conditions. Notably, based on the OLS estimator, the adjusted marginal disutilities for hydrocephalus; learning and physical disabilities; other syndromes and associations; meningitis, encephalitis, and other infections of the central nervous system; and microcephaly were estimated at -0.889 (95% confidence interval [CI]: -0.727, -1.000), -0.858 (95% CI: -0.727, -0.989), -0.838 (95% CI: -0.668, -1.000), -0.826(95% CI: -0.677, -0.975), and -0.820 (95% CI: -0.670, -0.970), respectively, when a perfect health threshold was applied, and -0.814 (95% CI: -0.656, -0.979), -0.783 (95%CI: -0.656, -0.918), -0.763 (95% CI: -0.597, -0.937), -0.751 (95% CI: -0.606, -0.904), and -0.745 (95% CI: -0.598, -0.899), respectively, when a normative childhood utility threshold was applied.
Our estimates and their associated distributions can be used for the purposes of QALY estimation by analysts conducting economic evaluations within the childhood context.

16 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Over the past decade, the power industry in many countries around the world has been undergoing massive changes to introduce competition. In power systems under transmission open access, an optimal schedule of generation of units to satisfy the demand at the minimum production and transmission costs with consideration of system operation constraints is an important issue. In this paper, a method for centralized economic dispatch in deregulated power systems is presented. The considered constraints are minimum and maximum power generation of units, capacity of transmission lines and ramp rate limits. A genetic algorithm is used to solve a nonlinear objective function. Simulations are performed on an IEEE 30-bus test system and the results are analyzed and commented.
    No preview · Conference Paper · Jun 2004
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of utility weights for the calculation of quality-adjusted life years is particularly problematic for pediatric health states. This article reviews variability in utility weights for intellectual disability and permanent hearing loss in economic evaluations of newborn screening and childhood immunizations. Utility weights for severe intellectual disability ranged from 0.06 to 0.74. Most studies either did not vary these utility weights in sensitivity analyses or assumed low variability; consequently, the robustness of cost-effectiveness estimates was not fully assessed. Two recently published catalogs of utility weights for pediatric health states also show wide divergences in estimates. More work is needed to establish measures of health utilities for childhood health states in order to allow for comparable assessments of pediatric interventions.
    No preview · Article · Jun 2010 · Expert Review of Pharmacoeconomics & Outcomes Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In the two-signal model of T cell activation, the outcome of antigen recognition is determined by the integration of multiple cues in the immune microenvironment. mTOR is an evolutionarily conserved PI3-kinase family member that plays a central role in integrating environmental cues in the form of amino acids, energy, and growth factors. Recently, an increasingly important role for mTOR in directing T cell activation and differentiation has become apparent. Here we review recent findings demonstrating the ability of mTOR to interpret signals in the immune microenvironment and program the generation of CD4(+) effector versus regulatory T cells, the generation of CD8(+) effector versus memory cells, T cell trafficking, and T cell activation versus anergy. The key theme to emerge from these studies is that the central role of mTOR provides a direct link between T cell metabolism and function.
    Full-text · Article · Sep 2010 · Immunity
Show more