B
Health Indexes

TABLE B-1 The Quality of Well-Being Scale (QWB)

Domains

Attribute Levels

Description

MOBILITY SCALE

5

No limitations for health reasons.

4

Did not drive a car, health related; did not ride in a car as usual for age (younger than 15 years), health related.

3

Did not use public transportation, health related.

2

Had or would have used more help than usual for age to use public transportation, health related.

1

In hospital, health related.

PHYSICAL ACTIVITY SCALE

4

No limitations for health reasons.

3

In wheelchair, moved or controlled movement of wheelchair without help from someone else.

2

Had trouble or did not try to lift, stoop, bend over, or use stairs or inclines, health related; limped, used a cane, crutches, or walker, health related; had any other physical limitation in walking; or did not try to walk as far or as fast as others the same age are able, health related.

1

In wheelchair, did not move or control the movement of wheelchair without help from someone else, or in bed, chair, or couch for most or all of the day, health related.

SOCIAL ACTIVITY SCALE

5

No limitations for health reasons.

4

Limited in other (e.g., recreational) role activity, health related.

3

Limited in major (primary) role activity, health related.

2

Performed no major role activity, health related, but did perform self-care activities.

1

Performed no major role activity, health related, and did not perform or had more help than usual in performance of one or more self-care activities, health related.



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Valuing Health for Regulatory Cost-Effectiveness Analysis B Health Indexes TABLE B-1 The Quality of Well-Being Scale (QWB) Domains Attribute Levels Description MOBILITY SCALE 5 No limitations for health reasons. 4 Did not drive a car, health related; did not ride in a car as usual for age (younger than 15 years), health related. 3 Did not use public transportation, health related. 2 Had or would have used more help than usual for age to use public transportation, health related. 1 In hospital, health related. PHYSICAL ACTIVITY SCALE 4 No limitations for health reasons. 3 In wheelchair, moved or controlled movement of wheelchair without help from someone else. 2 Had trouble or did not try to lift, stoop, bend over, or use stairs or inclines, health related; limped, used a cane, crutches, or walker, health related; had any other physical limitation in walking; or did not try to walk as far or as fast as others the same age are able, health related. 1 In wheelchair, did not move or control the movement of wheelchair without help from someone else, or in bed, chair, or couch for most or all of the day, health related. SOCIAL ACTIVITY SCALE 5 No limitations for health reasons. 4 Limited in other (e.g., recreational) role activity, health related. 3 Limited in major (primary) role activity, health related. 2 Performed no major role activity, health related, but did perform self-care activities. 1 Performed no major role activity, health related, and did not perform or had more help than usual in performance of one or more self-care activities, health related.

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Valuing Health for Regulatory Cost-Effectiveness Analysis Domains Attribute Levels Description SYMPTOM/PROBLEM COMPLEX 23 Trouble sleeping; intoxication; problems with sexual interest or performance; or excessive worry. 22 No symptoms or problem. 21 Breathing smog or unpleasant air. 20 Wore glasses or contact lenses. 19 Taking medication or staying on a prescribed diet for health reasons. 18 Pain in ear, tooth, jaw, throat, lips, tongue; several missing or crooked permanent teeth—includes wearing bridges or false teeth; stuffy, runny nose; or any trouble hearing—includes wearing a hearing aid. 17 Overweight for age and height or skin defect of face, body, arms, or legs, such as scars, pimples, warts, bruises, or changes in color. 16 Pain or discomfort in one or both eyes (such as burning or itching) or any trouble seeing after correction. 15 Trouble talking, such as lisp, stuttering, hoarseness, or being unable to speak. 14 Burning or itching rash on large areas of face, body, arms, or legs. 13 Headache, or dizziness, or ringing in ears, or spells of feeling hot, or nervous or shaky. 12 Spells of feeling upset, being depressed, or of crying. 11 Cough, wheezing, or shortness of breath, with or without fever, chills, or aching all over. 10 General tiredness, weakness, or weight loss. 9 Sick or upset stomach, vomiting or loose bowel movement, with or without fever, chills, or aching all over. 8 Pain, burning, bleeding, itching, or other difficulty with rectum, bowel movements, or urination (passing water). 7 Pain, stiffness, weakness, numbness, or other discomfort in chest, stomach (including hernia or rupture), side, neck, back, hips, or any joints or hands, feet, arms, or legs. 6 Any combination of one or more hands, feet, arms, or legs either missing, deformed (crooked), paralyzed (unable to move), or broken—includes wearing artificial limbs or braces. 5 Trouble learning, remembering, or thinking clearly. 4 Pain, bleeding, itching, or discharge (drainage) from sexual organs—does not include normal menstrual (monthly) bleeding. 3 Burn over large areas of face, body, arms, or legs. 2 Loss of consciousness such as seizure (fits), fainting, or coma (out cold or knocked out). 1 Death. Scoring algorithm: See Kaplan and Anderson (1988) or Patrick and Erickson (1993, pp. 389–391).

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Valuing Health for Regulatory Cost-Effectiveness Analysis TABLE B-2 The Health Utilities Index Mark 2 (HUI-2) Domains Attribute Levels Description SENSATION 1 Able to see, hear, and speak normally for age. 2 Requires equipment to see or hear or speak. 3 Sees, hears, or speaks with limitations even with equipment. 4 Blind, deaf, or mute. MOBILITY 1 Able to walk, bend, lift, jump, and run normally for age. 2 Walks, bends, lifts, jumps, or runs with some limitations but does not require help. 3 Requires mechanical equipment (such as canes, crutches, braces, or wheelchair) to walk or get around independently. 4 Requires the help of another person to walk or get around and requires mechanical equipment as well. 5 Unable to control or use arms and legs. EMOTION 1 Generally happy and free from worry. 2 Occasionally fretful, angry, irritable, anxious, depressed, or suffering “night terrors.” 3 Often fretful, angry, irritable, anxious, depressed, or suffering “night terrors.” 4 Almost always fretful, angry, irritable, anxious, depressed. 5 Extremely fretful, angry, irritable, anxious, or depressed usually requiring hospitalization or psychiatric institutional care. COGNITION 1 Learns and remembers school work normally for age. 2 Learns and remembers school work more slowly than classmates as judged by parents and/or teachers. 3 Learns and remembers very slowly and usually requires special educational assistance. 4 Unable to learn and remember. SELF-CARE 1 Eats, bathes, dresses, and uses the toilet normally for age. 2 Eats, bathes, dresses, or uses the toilet independently with difficulty. 3 Requires mechanical equipment to eat, bathe, dress, or use the toilet independently. 4 Requires the help of another person to eat, bathe, dress, or use the toilet. PAIN 1 Free of pain and discomfort. 2 Occasional pain. Discomfort relieved by nonprescription drugs or self-control activity without disruption of normal activities. 3 Frequent pain. Discomfort relieved by oral medicines with occasional disruption of normal activities.

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Valuing Health for Regulatory Cost-Effectiveness Analysis Domains Attribute Levels Description   4 Frequent pain; frequent disruption of normal activities. Discomfort requires prescription narcotics for relief.   5 Severe pain. Pain not relieved by drugs and constantly disrupts normal activities. FERTILITY 1 Able to have children with a fertile spouse. 2 Difficulty in having children with a fertile spouse. 3 Unable to have children with a fertile spouse. Scoring algorithm: See Torrance et al. (1996). Also available at http://www.fhs.mcmaster.ca/hui2.htm.

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Valuing Health for Regulatory Cost-Effectiveness Analysis TABLE B-3 The Health Utilities Index Mark 3 (HUI-3) Domains Attribute Levels Description VISION 1 Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, without glasses or contact lenses. 2 Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, but with glasses. 3 Able to read ordinary newsprint with or without glasses but unable to recognize a friend on the other side of the street, even with glasses. 4 Able to recognize a friend on the other side of the street with or without glasses but unable to read ordinary newsprint, even with glasses. 5 Unable to read ordinary newsprint and unable to recognize a friend on the other side of the street, even with glasses. 6 Unable to see at all. HEARING 1 Able to hear what is said in a group conversation with at least three other people, without a hearing aid. 2 Able to hear what is said in a conversation with one other person in a quiet room without a hearing aid, but requires a hearing aid to hear what is said in a group conversation with at least three other people. 3 Able to hear what is said in a conversation with one other person in a quiet room with a hearing aid, and able to hear what is said in a group conversation with at least three other people, with a hearing aid. 4 Able to hear what is said in a conversation with one other person in a quiet room, without a hearing aid, but unable to hear what is said in a group conversation with at least three other people even with a hearing aid. 5 Able to hear what is said in a conversation with one other person in a quiet room with a hearing aid, but unable to hear what is said in a group conversation with at least three other people even with a hearing aid. 6 Unable to hear at all. SPEECH 1 Able to be understood completely when speaking with strangers or friends. 2 Able to be understood partially when speaking with strangers but able to be understood completely when speaking with people who know me well. 3 Able to be understood partially when speaking with strangers or people who know me well.

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Valuing Health for Regulatory Cost-Effectiveness Analysis Domains Attribute Levels Description   4 Unable to be understood when speaking with strangers but able to be understood partially by people who know me well. 5 Unable to be understood when speaking to other people (or unable to speak at all). AMBULATION 1 Able to walk around the neighborhood without difficulty, and without walking equipment. 2 Able to walk around the neighborhood with difficulty; but does not require walking equipment or the help of another person. 3 Able to walk around the neighborhood with walking equipment, but without the help of another person. 4 Able to walk only short distances with walking equipment, and requires a wheelchair to get around the neighborhood. 5 Unable to walk alone, even with walking equipment. Able to walk short distances with the help of another person, and requires a wheelchair to get around the neighborhood. 6 Cannot walk at all. DEXTERITY 1 Full use of two hands and ten fingers. 2 Limitations in the use of hands or fingers, but does not require special tools or help of another person. 3 Limitations in the use of hands or fingers, is independent with use of special tools (does not require the help of another person). 4 Limitations in the use of hands or fingers, requires the help of another person for some tasks (not independent even with use of special tools). 5 Limitations in use of hands or fingers, requires the help of another person for most tasks (not independent even with use of special tools). 6 Limitations in use of hands or fingers, requires the help of another person for all tasks (not independent even with use of special tools). EMOTION 1 Happy and interested in life. 2 Somewhat happy. 3 Somewhat unhappy. 4 Very unhappy. 5 So unhappy that life is not worthwhile.

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Valuing Health for Regulatory Cost-Effectiveness Analysis Domains Attribute Levels Description COGNITION 1 Able to remember most things, think clearly and solve day-to-day problems. 2 Able to remember most things, but have a little difficulty when trying to think and solve day-to-day problems. 3 Somewhat forgetful, but able to think clearly and solve day-to-day problems. 4 Somewhat forgetful, and have a little difficulty when trying to think or solve day-to-day problems. 5 Very forgetful, and have great difficulty when trying to think or solve day-to-day problems. 6 Unable to remember anything at all, and unable to think or solve day-to-day problems. PAIN 1 Free of pain and discomfort. 2 Mild to moderate pain that prevents no activities. 3 Moderate pain that prevents a few activities. 4 Moderate to severe pain that prevents some activities. 5 Severe pain that prevents most activities. Scoring algorithm: Available at http://www.fhs.mcmaster.ca/hug/hui3.htm.

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Valuing Health for Regulatory Cost-Effectiveness Analysis TABLE B-4 The EuroQol-5D (EQ-5D) Domains Attribute Levels Description MOBILITY 1 I have no problems in walking about. 2 I have some problems in walking about. 3 I am confined to bed. SELF-CARE 1 I have no problems with self-care. 2 I have some problems washing or dressing myself. 3 I am unable to wash or dress myself. USUAL ACTIVITIES 1 I have no problems with performing my usual activities (e.g., work, study, housework, family or leisure activities). 2 I have some problems with performing my usual activities. 3 I am unable to perform my usual activities. PAIN/DISCOMFORT 1 I have no pain or discomfort. 2 I have moderate pain or discomfort. 3 I have extreme pain or discomfort. ANXIETY/DEPRESSION 1 I am not anxious or depressed. 2 I am moderately anxious or depressed. 3 I am extremely anxious or depressed. Scoring algorithm: See Shaw et al., 2005, for U.S. population-based preference weights. Scoring algorithms for statistical applications (SPSS, Stata, SAS) are available at the Agency for Healthcare Research Quality website, http://www.ahrq.gov/rice/.

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Valuing Health for Regulatory Cost-Effectiveness Analysis TABLE B-5 The SF-6D (SF-12 version) Domains Attribute Levels Description PHYSICAL FUNCTIONING 1 Your health does not limit you in moderate activities. 2 Your health limits you a little in moderate activities. 3 Your health limits you a lot in moderate activities. ROLE LIMITATIONS 1 You have no problems with your work or other regular daily activities as a result of your physical health or any emotional problems. 2 You are limited in the kind of work or other activities as a result of your physical health. 3 You accomplish less than you would like as a result of emotional problems. 4 You are limited in the kind of work or other activities as a result of your physical health and accomplish less than you would like as a result of emotional problems. SOCIAL FUNCTIONING 1 Your health limits your social activities none of the time. 2 Your health limits your social activities a little of the time. 3 Your health limits your social activities some of the time. 4 Your health limits your social activities most of the time. 5 Your health limits your social activities all of the time. PAIN 1 You have pain that does not interfere with your normal work (both outside the home and housework) at all. 2 You have pain that interferes with your normal work (both outside the home and housework) a little bit. 3 You have pain that interferes with your normal work (both outside the home and housework) moderately. 4 You have pain that interferes with your normal work (both outside the home and housework) quite a bit. 5 You have pain that interferes with your normal work (both outside the home and housework) extremely. MENTAL HEALTH 1 You feel downhearted and low none of the time. 2 You feel downhearted and low a little of the time. 3 You feel downhearted and low some of the time. 4 You feel downhearted and low most of the time. 5 You feel downhearted and low all of the time. VITALITY 1 You have a lot of energy all of the time. 2 You have a lot of energy most of the time. 3 You have a lot of energy some of the time. 4 You have a lot of energy a little of the time. 5 You have a lot of energy none of the time. Scoring algorithm: See Brazier and Roberts, 2004. Scoring algorithm and software are available from the authors.

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Valuing Health for Regulatory Cost-Effectiveness Analysis TABLE B-6 The Functional Capacity Index (FCI) Version 2.1 Final Domains Attribute Levels Description EXCRETORY FUNCTIONS A No limitations No accidents and no use of medication or devices B Controllable excretory difficulty (bowel and bladder) No accidents with use of medication or devices* or accidents once per week or less with or without use of medication or device* C2 Severe incontinence (bowel and bladder); Accidents every day or continuous use of catheter or colostomy pouch *device does not include catheter or colostomy pouch EATING A No limitation No limitations in chewing, swallowing, or digesting food that require restrictions in diet or special preparation of foods B Minor to moderate limitation Restrictions in diet or special preparation of foods required C Tube feeding and/or gastrostomy required SEXUAL FUNCTION A No limitations due to physical limitation B Some difficulty due to physical limitation C A lot of difficulty due to physical limitation including not being able to do it at all AMBULATION (MAY INCLUDE LIMITATIONS DUE TO PAIN) A No limitations walking, running, walking briskly, or standing for long periods No limitations walking without help from another person or device* No limitations running or walking briskly or standing for long periods B Some limitations running or walking briskly or standing for long periods No limitations walking without help from another person or device* But has some limitations running, walking briskly, or standing for long periods C1 Some limitations walking but independent (independent community ambulator) Has some limitations walking But can walk at least 150 yards (length of city block) without help from another person or device* C2 Can walk long distances but only with device or help (community ambulator with assistance) Has some limitations walking Can walk at least 150 yards (length of city block) but only with help from another person or device*

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Valuing Health for Regulatory Cost-Effectiveness Analysis Domains Attribute Levels Description   D Walking limited to short distances with or without device or help (home ambulator) Cannot walk 150 yards even with help or device* But can walk shorter distances (i.e. < 150 yards) with or without help from another person or device* E Cannot walk at all Cannot walk even short distances; requires wheelchair all the time to get around *Device includes walking aids (e.g. cane, crutch, walker) or prosthesis/orthosis BENDING, STOOPING, AND LIFTING (MAY INCLUDE LIMITATIONS DUE TO PAIN) A No difficulty bending, stooping, lifting and no difficulty lifting arms over head No difficulty lifting and carrying weights up to 50 lbs (a small child) No difficulty lifting arms over head B Minor difficulty bending, stooping, lifting, and/or difficulty lifting arms over head Has difficulty lifting and carrying 50 lbs (a small child), but can lift at least 10 lbs (a bag of groceries) with no or little difficulty and/or Has difficulty lifting arms over head but can do it at least 5 times in a row C Major difficulty bending, stooping, lifting Has a lot of difficulty lifting and carrying at least 10 lbs (a bag of groceries), including not being able to do it at all May or may not have difficulty lifting arms over head but can do it at least 5 times in a row D Complete or near complete loss of upper body function Has difficulty lifting and carrying at least 10 lbs (a bag of groceries), including not being able to do it at all Has difficulty lifting arms over head at least 5 times in a row, including not being able to do it at all HAND AND WRIST FUNCTION (MAY INCLUDE LIMITATIONS DUE TO PAIN) A No limitations No difficulty grasping and handling small or large objects with either hand No difficulty twisting and turning doorknob or key with either hand B1 Minor difficulty in hand and/or wrist function—one hand Difficulty grasping and handling small objects with one hand but no difficulty with large objects and/or Difficulty twisting and turning doorknob or key with one hand

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Valuing Health for Regulatory Cost-Effectiveness Analysis Domains Attribute Levels Description     May use special tool but does not require the help of another person B2 Minor difficulty in hand and/or wrist function—both hands Difficulty grasping and handling small objects with both hands but no difficulty with large objects and/or Difficulty twisting and turning doorknob or key with one or both hands May use special tool but does not require the help of another person C1 Major difficulty in hand function—one hand Difficulty grasping and handling large and small objects with one hand May or may not have difficulty twisting and turning doorknob or key with one or both hands May use special tool but does not require the help of another person C2 Major difficulty in hand function—both hands Difficulty grasping and handling large and small objects with both hands May or may not have difficulty twisting and turning doorknob or key with one or both hands May use special tool but does not require the help of another person D Near complete loss of hand function (including paralysis) Difficulty grasping and handling large and small objects Requires the help of another person for some, but not all tasks necessary for daily living E Complete loss of function (including paralysis) in both hands Difficulty grasping and handling large and small objects Requires the help of another person for all or nearly all tasks necessary for daily living SPEECH A No limitations B Minor limitations in everyday situations Can be understood by most everyone; may get stuck, stutter, stammer, slur C Major limitations Can only be understood by people who know person well D Cannot speak and/or be understood by others or requires voice box to speak HEARING A No limitations hearing without hearing aid B1 Minor difficulty hearing

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Valuing Health for Regulatory Cost-Effectiveness Analysis Domains Attribute Levels Description     With or without hearing aid has some difficulty hearing, but only when listening conditions are less than ideal B2 Moderate difficulty With or without hearing aid has difficulty hearing under everyday listening conditions C Profound to total loss of hearing; noncorrectable Cannot hear even with the use of a hearing aid VISION A No limitations; No difficulties reading small and large print, driving and going about daily activities with or without glasses/contacts B Minor or moderate limitations Minor or moderate difficulty reading small and large print, driving and going about daily activities with or without glasses/contacts C Severe limitations Severe difficulty reading small and large print, driving and going about daily activities with or without glasses/contacts; includes blind with light perception only D Blind without light perception COGNITIVE FUNCTION A No limitations B Minor limitations Minor difficulties with reasoning/solving problems, memory, concentration/thinking and/or attention; can live independently (i.e. does not require assistance with either ADL or IADL activities due to cognitive deficits) C Moderate to severe limitations Moderate to severe difficulties with reasoning/solving problems, memory, concentration/thinking and/or attention; can live independently (i.e. does not require assistance with ADL activities) but (due to cognitive deficits) may need assistance with some IADL activities of daily living D Unconfined dependence Cannot live independently due to cognitive deficits but 24-hour supervision is not required E Confined dependence Cannot live independently due to cognitive deficits; 24-hour supervision is required F Minimally responsive or vegetative state Cannot respond to simple commands except possibly with eye movement Scoring algorithm: See MacKenzie et al. (1996), for original FCI scores and classifications; contact author for current scoring algorithm.