Broadening the Measurement and Valuation of Health and Quality of Life

Mulhern, Brendan James

Broadening the Measurement and Valuation of Health and Quality of Life

Mulhern, Brendan James

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Publication Type:: Thesis
Issue Date:: 2020

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Field	Value	Language
dc.contributor.author	Mulhern, Brendan James
dc.date.accessioned	2020-08-31T03:22:32Z
dc.date.available	2020-08-31T03:22:32Z
dc.date.issued	2020
dc.identifier.uri	http://hdl.handle.net/10453/142429
dc.description	University of Technology Sydney. Faculty of Business.	en_AU
dc.description.abstract	Economic evaluation is an important tool in health care resource allocation. Interventions are typically evaluated through a cost utility analysis (CUA) using the Quality Adjusted Life Year (QALY), a metric combining length of life and quality of life (QoL) into a single outcome. The quality aspect of the QALY is often provided by a preference-based measure (PBM) that includes a way of measuring health, and a preference-based value set. The most commonly used PBMs focus on health-related quality of life (HRQoL). However, there is a case for broadening what is measured and valued by including other aspects of QoL (such as social care related QoL) alongside HRQoL. This thesis explores how methods for the measurement and valuation of health and QoL can be extended to inform the development of broader and more widely applicable instruments. This was investigated by first exploring how to incorporate QoL concepts into PBMs, and second by testing the further application of Discrete Choice Experiment (DCE) methods to value QoL. Three empirical studies were conducted The first study assessed existing measures of health and QoL using Item Response Theory (IRT), and tested two ways in which PBMs could be broadened to incorporate wider QoL concepts. The results demonstrated overlap and divergence in what is measured. This informed where extra dimensions of QoL could broaden the information collected, and how the information collected within existing HRQoL frameworks could be extended. The second study used DCE to understand respondent preferences for diverse dimensions of QoL. The results provided evidence respondents do trade across different concepts of QoL. This supports the need for broader measures, and also the use of DCE to value broader outcomes. The third study focuses on DCE methods, and particularly on the construction of designs for DCEs. The results provided detailed information about different design strategies for the valuation of QoL outcomes. The overall findings raise key issues about what should be captured in PBMs, and also provide novel information about methods that can be used to inform the assessment, development and valuation of future instruments. For example, the results inform how IRT can be used in PBM development. They also suggest how DCE can be used to value diverse QoL concepts. This can inform the development and valuation of broader measurement systems of QoL outcomes that can increase the scope and enhance the applicability of QALY values used in resource allocation decision making.	en_AU
dc.format	Thesis (PhD)
dc.language.iso	en_US	en_US
dc.relation	https://opus.lib.uts.edu.au/bitstream/10453/142429/2/02whole.pdf
dc.rights	au.edu.uts.lib/ppc
dc.rights	The author owns the copyright in this thesis including all reproduction and reuse rights for the work. The work may not be altered without the permission of the copyright owner. Attribution is essential when quoting or paraphrasing from this thesis.
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Broadening the Measurement and Valuation of Health and Quality of Life	en_AU
dc.type	Thesis
utslib.copyright.status	open_access	*

Abstract:

Economic evaluation is an important tool in health care resource allocation. Interventions are typically evaluated through a cost utility analysis (CUA) using the Quality Adjusted Life Year (QALY), a metric combining length of life and quality of life (QoL) into a single outcome. The quality aspect of the QALY is often provided by a preference-based measure (PBM) that includes a way of measuring health, and a preference-based value set. The most commonly used PBMs focus on health-related quality of life (HRQoL). However, there is a case for broadening what is measured and valued by including other aspects of QoL (such as social care related QoL) alongside HRQoL. This thesis explores how methods for the measurement and valuation of health and QoL can be extended to inform the development of broader and more widely applicable instruments. This was investigated by first exploring how to incorporate QoL concepts into PBMs, and second by testing the further application of Discrete Choice Experiment (DCE) methods to value QoL. Three empirical studies were conducted The first study assessed existing measures of health and QoL using Item Response Theory (IRT), and tested two ways in which PBMs could be broadened to incorporate wider QoL concepts. The results demonstrated overlap and divergence in what is measured. This informed where extra dimensions of QoL could broaden the information collected, and how the information collected within existing HRQoL frameworks could be extended. The second study used DCE to understand respondent preferences for diverse dimensions of QoL. The results provided evidence respondents do trade across different concepts of QoL. This supports the need for broader measures, and also the use of DCE to value broader outcomes. The third study focuses on DCE methods, and particularly on the construction of designs for DCEs. The results provided detailed information about different design strategies for the valuation of QoL outcomes. The overall findings raise key issues about what should be captured in PBMs, and also provide novel information about methods that can be used to inform the assessment, development and valuation of future instruments. For example, the results inform how IRT can be used in PBM development. They also suggest how DCE can be used to value diverse QoL concepts. This can inform the development and valuation of broader measurement systems of QoL outcomes that can increase the scope and enhance the applicability of QALY values used in resource allocation decision making.

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