PharmacoEconomics

, Volume 7, Issue 5, pp 403–415 | Cite as

The Short-Form 36 (SF-36) Health Survey and Its Use in Pharmacoeconomic Evaluation

  • John Brazier
Review Article

Summary

The Short-Form 36 (SF-36) Health Survey is a brief self-administered questionnaire that generates scores across 8 dimensions of health. It has been found to be reliable, and valid in terms of criteria such as agreement with clinical diagnosis and disease severity, but its underlying values have not been tested against patient preferences.

The SF-36 was not devised for use in economic evaluation. The SF-36 may be used in cost-minimisation analyses. where the dimension scores can be shown to reflect people’s values for health at an ordinal level, but it cannot be used in either cost-effectiveness or cost-utility analyses. The dimension scores of zero to 100 do not provide a common currency and, where there is conflict between the dimension scores, there is no basis for establishing an overall health benefit. Furthermore, in clinical trials, the usual comparison is between mean or median scores, which assumes risk neutrality and docs not take adequate account of the relationship between the value of health and time.

Although they are under pressure to assess the cost effectiveness of health care interventions, researchers and policy analysts must resist short-cut methods of deriving a single index, from the SF-36 that are based on arbitrary aggregation schemes, because these ignore people’s preferences and the crucial quantity/ quality trade-off, and therefore cannot be used in economic evaluations. However, the rich descriptive material and multidimensionality of the SF-36 may have potential for use in economic evaluation. Multi-attribute utility theory provides a way of deriving a single index based on elicited values, but it requires a major restructuring of the scales of the SF-36. Alternatively, SF-36 rcsponses may provide material for constructing health scenarios that could then be valued on a holistic basis.

Keywords

Economic Evaluation Single Index Standard Gamble Expect Utility Theory Dimension Score 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Drummond MF. Cost–effectiveness guidelines for reimbursement of pharmaceuticals: is economic evaluation ready for its enhanced status? Health Econ 1992: 1: 85–92PubMedCrossRefGoogle Scholar
  2. 2.
    Ellwood PM. Outcomes management: a technology of patient experience. N Engl J Med 1988; 318: 1549–56PubMedCrossRefGoogle Scholar
  3. 3.
    Ware JE, Sherbourne CD. The MOS 36–item Short–Form Health Survey (SF–36): I. Conceptual framework and item selection. Med Care 1992; 30: 473–83PubMedCrossRefGoogle Scholar
  4. 4.
    Aaronson NK, Acquadro C, Alonso J, et al. International quality of life assessment (QOLA) project. Qual Life Res 1992; 1: 349–51PubMedCrossRefGoogle Scholar
  5. 5.
    Torrance GW. Social preferences for health states: an empirical evaluation of three measurement techniques. Socioecon Plan Sci 1976; 10 (3): 128–36Google Scholar
  6. 6.
    Torrance GW. Multi–attribute utility theory as a method of measuring social preferences for health states in long–term care. In: Kane RL, Kane RA, editors. Values in long term care. Lexington: Lexington Books DC Health and Company, 1982Google Scholar
  7. 7.
    Kaplan RM, Anderson JP. The general health policy model: an integrated approach. Quality of life assessments in clinical trials. New York: Raven Press Ltd. 1990Google Scholar
  8. 8.
    Kaplan RM, Bush JW, Berry C. Health status: types of validity and the index of welI–being. Health Serv Res 1976 Winter; 11 (4): 478–507PubMedGoogle Scholar
  9. 9.
    Kaplan RM, Bush JW. Health–related quality of life measurement for evaluation of research and policy analysis. Health Psychol 1982; 1 (1): 61–80CrossRefGoogle Scholar
  10. 10.
    The Euroqol group. Euroqol: a new facility for the measurement of health related quality of life. Health Policy 1990; 16 (3): 199–208PubMedCrossRefGoogle Scholar
  11. 11.
    Medical Outcomes Trust. How to score the SF–36 Health Survey. Boston: Medical Outcome Survey, 1993Google Scholar
  12. 12.
    Brook RH, Ware JE, Roberts WR, et al. Does free care improve adults’ health? Results from a randomised controlled trial. N Engl J Med 1983; 309: 1426–34PubMedCrossRefGoogle Scholar
  13. 13.
    Brook RH, Ware JE, Davies–Avery A, et al. Overview of adult health status measures fielded in Rand’s Health lnsurance Study. Med Care 1979; 17 Suppl.: 7Google Scholar
  14. 14.
    Tarlov AR, Ware JE, Greenfield S, et al. The medical outcomes study: an application of methods for monitoring the results of medical care. JAMA 1983; 262: 925–30CrossRefGoogle Scholar
  15. 15.
    Ware JE, Snow KK, Kosinski M, et al. SF–36 Health Survey manual and interpretation guide. Boston: The Health Institute,New England Medical Center, 1993Google Scholar
  16. 16.
    Nunnally JC. Psychometric theory. New York: McGraw–Hill Book Co., 1967Google Scholar
  17. 17.
    McDowell I, Newell C. Measuring health. A guide to rating scales and questionnaire. Oxford: Oxford University Press, 1987Google Scholar
  18. 18.
    Stewart AL, Ware J, editors. Measuring functioning and wellbeing. Durham, NC: Duke University Press, 1992Google Scholar
  19. 19.
    McHorney CA, Ware JE, Lu JFR, et al. The: MOS 36–item Short Form Health Survey (SF–36): III. Test of data quality, assumptions and reliabilily across diverse patient groups. Med Care: 1994; 32: 40–52PubMedCrossRefGoogle Scholar
  20. 20.
    Stewart AL, Hays RD, Ware JE. The MOS short–form General Health Survey: reliability and validity in a patient population. Med Care 1988; 26 (7): 724–35PubMedCrossRefGoogle Scholar
  21. 21.
    Brazier JE, Harper R, Jones NMB, et al. Validating the SF–36 health survey questionnaire: new outcome measure for primary care. WHO: Constitution of the World Health Organisation, Documents. Geneva: WHO, 1948. BMJ 1992; 305; 160–4PubMedCrossRefGoogle Scholar
  22. 22.
    Ware JE. Standards for validating health measures: definition and content. J Chronic Dis 1987; 40 (6): 473–80PubMedCrossRefGoogle Scholar
  23. 23.
    Hunt SM, McEwen J, McKenna SP. Measuring health Status. London: Croom Helm, 1986Google Scholar
  24. 24.
    Carter W, Bobbitt R, Bergner M, et al. Validation of an interval scaling: the sickness impact profile. Health Serv Res 1976; 11: 516–28PubMedGoogle Scholar
  25. 25.
    Mchorney CA, Ware JE, Raczek AK. The MOS 36–item Short Form Health Survey (SF–36): II. Psychometric and clinical test of validity in measuring physical and mental heallh constructs. Med Care 1993: 31: 247–63PubMedCrossRefGoogle Scholar
  26. 26.
    Garrat AM, Ruta DA, Abdalla MI, et al. The SF–36 health survey questionnaire: an outcome measure suitable for routine use within the NHS. BMJ 1993; 306: 1440–4CrossRefGoogle Scholar
  27. 27.
    Vickrey BG, Mays RD, Graber J, et al. A health–related quality of life instrument for patients evaluated for epilepsy surgery. Med Care 1992; 30: 299–319PubMedCrossRefGoogle Scholar
  28. 28.
    Nerenz DR, Repasky YP, Whitehouse MD, et al. Ongoing assessment of health status in patients with diabetes mellitus using the SF–36 and diabetes TYPE scale. Med Care 1992; 30 (5): MS240–52Google Scholar
  29. 29.
    Kurtin PS, Davies AR, Meyer KB, et al. Patient–based health status measurements in outpatient dialysis: early experiences in developing an outcomes assessment program. Med Care 1992; 30 (5): MS136–49PubMedCrossRefGoogle Scholar
  30. 30.
    Berwick OM, Murphy JA, Goldman PA, et al. Performance of a five item mental health screening test. Med Care 1991; 29 (2): 169–76PubMedCrossRefGoogle Scholar
  31. 31.
    Katz JN, Larson MG, Phillips CB, et ul. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30: 917–25PubMedCrossRefGoogle Scholar
  32. 32.
    Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF–36 health survey questionnaire. Qual life Res 1993: 2: 169–80PubMedCrossRefGoogle Scholar
  33. 33.
    Williams A. Measuring functioning and well–being, by Stewart and Ware. Health Econ 1992; 1 4): 255–8CrossRefGoogle Scholar
  34. 34.
    Deyo RA, Lnui TS. Toward clinical applications of health Status measures: sensitivity of scales to clinically important changes [editorial]. Health Serv Res 1984: 19 (3): 275PubMedGoogle Scholar
  35. 35.
    Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987Google Scholar
  36. 36.
    Cairns J, Johnston K, McKenzie L. Developing QALYs from condition specific outcome measures. HERU DP 14/91. Aberdeen: University of Aberdeen, 1991Google Scholar
  37. 37.
    Loomes G, McKenzie L. The use of QALYs in health care decision making. Soc Sci Med 1989: 28 (4): 299–308PubMedCrossRefGoogle Scholar
  38. 38.
    Gafni A, Birch S, Mehrez A, Economics, health and health economics: HYEs vs. QALYs. J Health Econ 1993; 12 (3): 325–40PubMedCrossRefGoogle Scholar
  39. 39.
    Culyer AJ, Wagstaff A, QALYs vs. HYEs. J Health Econ 1993; 12 (3): 311–24PubMedCrossRefGoogle Scholar
  40. 40.
    Nicholl J, Brazier JE, Milner PC, et al. Randomised controlled trial of cost–ffectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones. Lancet 1992: 340: 801–7PubMedCrossRefGoogle Scholar
  41. 41.
    Gudex C. QALYs and their use by the Health Service [Discussion Paper 20]. York: Centre for Health Economics, University of York, 1986Google Scholar
  42. 42.
    Sackett DL, Torrance GW, The utility of different health states as perceived by the general public. J Chronic Dis 1978: 31 (11); 697–709PubMedCrossRefGoogle Scholar
  43. 43.
    Richardson J, Hall J, Salkeld G. CUA: the compatibility of measurement techniques and the measurement of ulility through time. In: Selby-Smith C, editor. Economics and Health Clayton, VIC: Monash University, 1989: 31–52Google Scholar
  44. 44.
    Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986; 5; 1–19PubMedCrossRefGoogle Scholar
  45. 45.
    Revicki DA, Kaplan RM, Relationship between psychometric and utility–based approaches to the measurement of health related quality of life. Qual Life Res 1993: 2 (3): 477–87PubMedCrossRefGoogle Scholar
  46. 46.
    Revicki DA, Relationship between health utility and psychometric health status measures. Med Care 1992; 30 (Suppl.): MS274–82CrossRefGoogle Scholar
  47. 47.
    Katz JN, Phillips CB, Fossel AH, et al. Stability and responsivenes of utility measures. Med Care 1994; 32 (2): 183–8PubMedCrossRefGoogle Scholar
  48. 48.
    Laupacis A. The Canadian Erythropoietin Study Group. BMJ 1990; 300: 573–8CrossRefGoogle Scholar
  49. 49.
    O’Brien BJ, Buxton MJ, Ferguson BA. Measuring the effetiveness of heart transplant programmes: quality of life data and their relationship to survival analysis. J Chronic Dis 1987; 40 (1): 1375–85Google Scholar
  50. 50.
    McKenna S, Hunt SM, Tennant A. The development of a patient–completed index of distress from the Nottingham Health Profile: a new measure for use in cost–utility studies, Br J Med Econ 1993; 6: 13–24Google Scholar
  51. 51.
    Feeny D, Furlong W, Barr RD, et al. A comprehensive multi–attribute system for classifying the health status of survivors of childhood cancer. J Clin Oncol 1992; 10 (6); 923–8PubMedGoogle Scholar
  52. 52.
    Keeney RL, Raiffa H, Decisions with multiple objectives: preferences and value tradeoffs, New York: John Wiley and Sons, 1976Google Scholar
  53. 53.
    Brazier JE. The SF–36 Health Survey Questionnaire–a tool for economics. Health Econ 1993: 2: 213–5PubMedCrossRefGoogle Scholar
  54. 54.
    Brazier JE, Usherwood T, Harper R, et al. Deriving a single index for health from the SF–36: interim report for the Department of Health, Sheffield: University of Sheffield, 1994Google Scholar
  55. 55.
    Hall J, Gerard K, Salkeld G, et al. A cost utility analysis of mammography screening in Australia. Soc Sci Med 1992; 34 (9): 993–1004PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • John Brazier
    • 1
  1. 1.Sheffield Centre for Health and Related ResearchUniversity of SheffieldEngland

Personalised recommendations