Social Evaluation Of Health Care Versus Personal Evaluation Of Health States: Evidence On The Validity Of Four Health State Scaling Instruments Using Norwegian And Australian Survey Data

In most of the cost-utility literature, QALY gains are interpreted as a measure of social value. Given this interpretation, the validity of different multi-attribute health state scaling instruments may be tested by comparing the values they provide on the 0-1 QALY-scale with directly elicited preferences for person trade-offs between different treatments (equivalence of numbers of different patients treated). Norwegian and Australian public preferences as measured by the person trade-off suggest that the EuroQol Instrument assigns excessively low values to health states. This seems to be even more true of the McMaster Health Classification System. The Quality of Well-Being Scale appears to compress states towards the middle of the 0-1 scale. By contrast the Rosser/Kind index fits reasonably well with directly measured person trade-off data.