Do Generic Population Utility Scores Accurately Represent Real-World Experienced Health?

OBJECTIVES: Societal weights, derived through the anticipated utility approach where individuals assess the impact of hypothetical health states on their quality of life, are employed to represent health-related quality of life (HRQOL) in EQ-5D-3L health states. This study aims to evaluate the extent to which these weights align with self-reported health statuses as experienced in the real world.

METHODS: Using data from the national Risk Factors survey in Argentina, we examined the relationship between HRQOL societal weights for EQ-5D-3L health states, as estimated by Augustovski (2009), and the self-reported health statuses from a nationally representative sample. Survey weights were applied to ensure national representativeness. We linked 163 distinct EQ-5D-3L health states to their respective HRQOL societal weights (ranging from 0 to 1, with 1 being the highest possible HRQOL value) and assessed the relationship between these weights and the probability of self-reported health states (from excellent to poor) using a multinomial-logistic regression. A fourth-degree polynomial function was employed as predictors to identify the best model fit (AIC and BIC).

RESULTS: A nonlinear relationship between HRQOL societal weights and self-reported health status was revealed. The probability distribution of reporting 'poor' health increased with HRQOL values up to 0.16, after which it decreased monotonically. Conversely, the distribution of reporting 'good' health showed an inverse trend. A positive, monotonic linear relationship was found between HRQOL measures and the distribution of reporting ‘very good' or 'excellent' health statuses.

CONCLUSIONS: HRQOL societal values obtained from an anticipated utility approach may fail to accurately reflect the true health experiences of individuals, particularly those with lower HRQOL. This inaccuracy is critical within the range where health deterioration is not adequately represented by societal HRQOL weights. The findings underscore the importance of adopting an experienced utility approach to generate societal weights that more accurately represent health experiences for informed health policy-making.