Utility Scores for Comorbid Conditions: Methodological Issues and Advances

  • C. N. McIntosh


 Utility scores quantify  health-related quality of life (HRQOL) along a continuum that typically ranges from 0.0 (dead) to 1.0 (full health), and are essential in developing  summary measures of population health (SMPH), as well as performing  cost-effectiveness analysis (CEA) of different treatments and intervention strategies. A key methodological issue is that traditionally, utility scores have been developed primarily for single health conditions, even though comorbidities are common in both general and patient populations.

Inaccuracies in health measurement are likely to occur when  comorbidity is ignored in the estimation of utility scores. In this chapter, methodological issues and advances with regard to deriving utility scores for comorbid health conditions are reviewed.

Direct utility elicitation protocols such as the standard gamble (SG) or time trade-off (TTO) are the most theoretically desirable approaches, but are cognitively burdensome for raters. With population survey data, scores from utility-based HRQOL instruments (e.g., the Health Utilities Index) can often be computed for self-reported comorbidities, but this strategy is often constrained by the limited number of conditions queried, as well as potentially compromised by self-report bias. Another suggested, yet little-used strategy is to map the expected impact of a given comorbidity into the descriptive system of a generic, multiattribute utility instrument, and then compute the corresponding utility score with the scoring algorithm.

Convenient mathematical models (e.g., additive, multiplicative, minimum) for combining single-condition utility scores have also been proposed, but the empirical evidence for their performance is mixed, as well as difficult to assess due to a lack of standardization in utility instrumentation and analytical procedures used. An “encompassing” mathematical model that subsumes traditional models as special cases appears to be more accurate, but has only been examined with respect to directly elicited utilities in the prostate cancer context. A crucial next step is evaluating its performance with respect to a wider variety of health conditions and data sources.

In future work on evaluating and refining methods for obtaining comorbidity-related utilities, cross-study comparability can be enhanced by striving for more consistency in utility instrumentation and analytical techniques.


Utility Score Multiplicative Model Full Health National Population Health Survey Suboptimal Health State 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


15-Dimensions Index


 burden of disease


Canadian Community Health Survey


Clinical Classification Category


cost-effectiveness analysis


congestive heart failure


Classification and Measurement System of Functional Health


chronic obstructive pulmonary disease


disutility score


EeuroQol Five Dimensions Index


global burden of disease


health-related quality of life


Health Utilities Index Mark III


International Classification of Diseases-Ninth Revision


Ischemic Heart Disease


Medical Expenditures Panel Survey


Canadian National Population Health Survey


Ontario Diabetes Database


Ontario Health Survey


population attributable risk


Panel on Cost-Effectiveness in Health and Medicine


person trade-off


quality-adjusted life year


Quality of Well-Being Index


Quality of Well-Being Index – Self-Administered


relative risk


Short-Form Six Dimensions Index


socio-economic status


standard gamble


summary measure of population health


time trade-off


utility score


World Health Organization


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  • C. N. McIntosh

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