Preference Weighting of Health State Values: What Difference Does It Make, and Why?

Background: Most patient-reported outcome measures apply a simple summary score to assess health-related quality of life, whereby equal weight is normally assigned to each item. In the generic preference-based instruments, utility weighting is essential whereby health state values are estimated through preference elicitation and complex algorithms. Objectives: To examine the extent to which preference-weighted value sets differ from unweighted values in the five-level EuroQol five-dimensional questionnaire and the 15D instrument, on the basis of a comprehensive data set from six member countries of the Organisation for Economic Co-operation and Development, each with a representative healthy sample and seven disease groups (N = 7933). Methods: Construct validities were examined. The level of agreement between preference-weighted and unweighted values was also assessed using intraclass correlation coefficient (ICC), Bland-Altman plots, and reduced major axis regression. Results: The performances of preference-weighted and unweighted measures were comparable with regard to convergent and known-group validities for each instrument. Although unweighted values in the five-level EuroQol five-dimensional questionnaire differ considerably from the preference-weighted values at the individual level, the discrepancy is minimal at the group level with a mean difference of 0.023. The ICC (0.96) and the Bland-Altman plot also suggest strong overall agreement. For the 15D, both the ICC (0.99) and the Bland Altman plot revealed almost perfect agreement, with a negligible mean difference of 0.001. Results from the reduced major axis regression also showed small bias. Conclusions: Overall, preference weighting has minimal effect if the unweighted values are anchored on the same scale as the preference-weighted value sets.