Neumann P J, Sandberg E A, Araki S S, Kuntz K M, Feeny D, Weinstein M C
Program on the Economic Evaluation of Medical Technology, Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Med Decis Making. 2000 Oct-Dec;20(4):413-22. doi: 10.1177/0272989X0002000405.
The Health Utilities Index (HUI) is a generic, multiattribute, preference-based health-status classification system. The HUI Mark 3 (HUI3) differs from the earlier HUI2 by modifying attributes and allowing more flexibility for capturing high levels of impairment. The authors compared HUI2 and HUI3 scores of patients with Alzheimer's disease (AD) and caregivers, and contrasted results of a cost-effectiveness analysis of new drugs for AD using the two systems.
In a cross-sectional study of 679 AD patient/caregiver pairs, stratified by patient's disease stage (questionable/mild/moderate/severe/profound/terminal) and setting (community/assisted living/nursing home), caregivers completed the combined HUI2/HUI3 questionnaire as proxy respondents for patients and for themselves.
Mean (SD) global utility scores for patients were lower on the HUI3 (0.22[0.26]) than on the HUI2 (0.53 [0.21]). Patient HUI3 utility scores ranged from 0.47(0.24) for questionable AD to -0.23 (0.08) for terminal AD, compared with a range of 0.73 (0.15) to 0.14 (0.07) for the HUI2. Among the 203 patients in the severe, profound, and terminal stages, 96 (48%) had negative global HUI3 utility scores, while none had a negative HUI2 score. The utility scores for caregivers were similar on the HUI3 (0.87 [0.14]) and HUI2 (0.87 [0.11]). Cost-effectiveness analysis of a new medication to treat AD showed somewhat more favorable results using the HUI3.
The HUI2 and HUI3 discriminate well across AD stages. Compared with the HUI2, the HUI3 yields lower global utility scores for patients with AD, and more scores for states judged worse than dead. The HUI3 may yield substantially different results from the HUI2, particularly for persons who have serious cognitive impairments such as AD.
健康效用指数（HUI）是一种通用的、多属性的、基于偏好的健康状况分类系统。HUI Mark 3（HUI3）与早期的HUI2不同，它修改了属性，并在捕捉高水平损伤方面具有更大的灵活性。作者比较了阿尔茨海默病（AD）患者及其照料者的HUI2和HUI3得分，并对比了使用这两种系统对AD新药进行成本效益分析的结果。
在一项对679对AD患者/照料者的横断面研究中，根据患者的疾病阶段（可疑/轻度/中度/重度/极重度/终末期）和环境（社区/辅助生活/疗养院）进行分层，照料者作为患者及其自身的代理应答者完成HUI2/HUI3联合问卷。
患者的平均（标准差）总体效用得分在HUI3上（0.22[0.26]）低于HUI2（0.53[0.21]）。患者的HUI3效用得分范围从可疑AD的0.47（0.24）到终末期AD的-0.23（0.08），而HUI2的范围是0.73（0.15）到0.14（0.07）。在重度、极重度和终末期的203名患者中，96名（48%）的总体HUI3效用得分为负，而HUI2得分均无负分。照料者的效用得分在HUI3（0.87[0.14]）和HUI2（0.87[0.11]）上相似。一种治疗AD的新药的成本效益分析显示，使用HUI3时结果略更有利。
HUI2和HUI3在AD各阶段的区分效果良好。与HUI2相比，HUI3使AD患者的总体效用得分更低，且对于比死亡更差状态的得分更多。HUI3可能产生与HUI2显著不同的结果，特别是对于患有严重认知障碍如AD的人。
