OBJECTIVES : Economic evaluations conducted to inform healthcare resource allocation often rely on quality-adjusted life years (QALYs) to measure therapeutic benefit. However, QALYs, with underlying health utilities estimated using the EQ5D or SF36, may fail to capture the full impact of disease as they do not robustly quantify physical and cognitive limitations. We explored how well-being and heath utility can differ across diseases.

METHODS : This study examined 8 conditions: arthritis, asthma, cancer, depression, diabetes, heart disease, lung disease, and stroke. Health utilities for each condition were obtained from published literature. Other measures of disease burden were estimated from the National Health and Nutrition Examination Survey (NHANES). The 2015-2016 physical functioning (PF) and physical activity (PA) questionnaires were used to measure PF and PA while the 2013-2014 Digit Symbol Substitution Test was used to measure cognitive functioning. Group rankings by these measures were compared to rankings by health utility.

RESULTS : Health utilities were lowest for depression (0.44) and stroke (0.76), and highest for those with cancer (0.81) and diabetes (0.79). Physical functioning was worst (higher score) among those with stroke (28.2), lung disease (27.3), and depression (27.1) and best for cancer (24.4) and diabetes (24.6). Physical activity was most impacted by heart disease (27.3) and lung disease (29.0), and least impacted by depression (40.7). Cognitive functioning was worst (41.6) in stroke and best (52.0) in asthma.

CONCLUSIONS : Differences in rankings of disease severity by utilities and by well-being metrics demonstrate that utilities, and results of cost-utility analyses that use them, might be biased against treatments for certain conditions. As patient preferences for clinical outcomes vary, the full burden of disease should be considered in evaluations. Restricting access to treatments based on an incomplete estimate of burden could lead to misallocation of resources and a withholding of therapies that patients find valuable.