Rating of arthritis health states by patients, physicians, and the generalpublic. Implications for cost-utility analyses

We elicited preferences for 2 arthritis health states (mild and severe) usi ng visual analog scales, time tradeoff, and standard gamble by interviewing 104 individuals from the general public, 51 patients with rheumatoid arthr itis, and 43 health professionals. The health scenarios were based on attri butes described in a health status classification instrument, the EuroQol ( EQ-5D). In addition, we compared the ratings in our survey with those obtai ned far the same scenarios by one of the scoring algorithms used for the EQ -5D (York weights). Statistically significant differences were observed in the ratings of the health scenarios, mostly for the severe vignette. Most o f the variability was related to the method employed. The cost-utility rati o for a hypothetical intervention varied according to the method employed t o determine the utility of the health states, from $15,000 to $111,000 US p er quality adjusted life year (QALY). Patient derived weights resulted in c ost-utility ratios that ranged from $39,000 to $222,000. Our findings show that the methodology used to elicit and analyze utilities can have substant ial implications in the economic evaluation of interventions for patients w ith RA.