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J R Soc Med. 1993 August; 86(8): 444–448.
PMCID: PMC1294046

Impact of diagnosis on utilities assigned to states of illness.


This paper addresses some of the fundamental issues surrounding the measurement of quality of life in relation to health care and highlights the need for continuous and careful review. Healthy volunteers were used to study the effect of diagnosis on the utilities placed on three dimensions of health-related quality of life encompassing 17 states of disability, distress, and discomfort including pain. The standard gamble (SG) was used to elicit values for appropriate levels of each dimension for selected diagnostic conditions. It was shown that clinical diagnosis affects the utilities that people assign to different states of ill-health. Mental conditions were consistently assigned lower utilities with subjects attributing their decisions to the social unacceptability and intractability associated with these conditions. These findings suggest that the comprehensiveness of the descriptive system for health indicators and profiles is important and should be kept under review. Furthermore, these data have implications for the role of the Quality Adjusted Life Years (QALY) estimates which assume that utility is uniform across various conditions. Finally, the study may have implications for mental health services if other population samples were to accord such high priority to the relief of mental conditions.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Devlin HB. Audit and the quality of clinical care. Ann R Coll Surg Engl. 1990 Jan;72(1 Suppl):3–14. [PubMed]
  • Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. [PubMed]
  • Rosser RM. 16. Recent studies using a global approach to measuring illness. Med Care. 1976 May;14(5 Suppl):138–147. [PubMed]
  • Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chronic Dis. 1978;31(11):697–704. [PubMed]
  • Rosser R, Kind P. A scale of valuations of states of illness: is there a social consensus? Int J Epidemiol. 1978 Dec;7(4):347–358. [PubMed]
  • Blaxter M. Evidence on inequality in health from a national survey. Lancet. 1987 Jul 4;2(8549):30–33. [PubMed]
  • Klein R. The role of health economics. BMJ. 1989 Jul 29;299(6694):275–276. [PMC free article] [PubMed]
  • Carr-Hill RA. Assumptions of the QALY procedure. Soc Sci Med. 1989;29(3):469–477. [PubMed]
  • Loomes G, McKenzie L. The use of QALYs in health care decision making. Soc Sci Med. 1989;28(4):299–308. [PubMed]
  • Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E. A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health. 1980 Dec;34(4):281–286. [PMC free article] [PubMed]
  • Bergner M, Bobbitt RA, Kressel S, Pollard WE, Gilson BS, Morris JR. The sickness impact profile: conceptual formulation and methodology for the development of a health status measure. Int J Health Serv. 1976;6(3):393–415. [PubMed]
  • Harris J. QALYfying the value of life. J Med Ethics. 1987 Sep;13(3):117–123. [PMC free article] [PubMed]

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