A comparison of five multi attribute utility instruments

Abstract This paper presents the results of the validation study carried out to evaluate the Assessment of Quality of Life (AQoL) Instrument for the measurement of health related quality of life and utility. It involves, inter alia, the largest comparison of utility instruments that has been carried out to date. The five instruments included in the study are the AQoL, the Canadian HUI III, the Finnish 15D, the EuroQoL (EQ5D) and the SF36 with UK utility weights as quantified by Brazier (1998). The paper compares: (i) the absolute utility score obtained by different sub-populations; (ii) instrument sensitivity; (iii) the incremental differences in utility between different health states; (iv) the structural properties of descriptive systems; and (v) a limited comparison with a Time Trade-Off (TTO) assessment of own health by individuals. Using these criteria the AQoL performs very well. Its predicted utilities are very similar to those obtained from the HUI. There is evidence that the AQoL has greater sensitivity to health states than other instruments and its psychometric properties, as usually judged, are excellent. Despite this, it is concluded that, at present, no single MAU system can claim to be the gold standard and that researchers should select an instrument that is sensitive to the health states which they are investigating and that caution should be exercised in treating any of the instrument results as representing a utility score which truly represents a trade-off between life and health related quality of life

Priorities of health policy: cost shifting or population health

BACKGROUND: This paper is an edited version of an invited paper submitted to the Australian Health Care Summit on 17–19 August 2003. It comments upon the policies which have dominated recent debate and contrasts their importance with the importance of five issues which have received relatively little attention. METHODS: Policy is usually a response to identified problems and the paper examines the nature and size of the problems which heave led to recent policy initiatives. These are contrasted with the magnitude and potential cost effectiveness policies to address the problems in five areas of comparative neglect. RESULTS: It is argued that recent and proposed changes to the financing and delivery of health services in Australia have focused upon issues of relatively minor significance while failing to address adequately major inequities and system deficiencies. CONCLUSION: There is a need for an independent review of the health system with the terms of reference focusing attention upon large system-wide failures

Device for on-site Production of Sterile Water for Injection in a Disaster Zone

This project sought to design and produce a device for the on-site manufacture of sterile water to be subsequently used to produce IV fluid in disaster zone. In order to accomplish this, the water produced must be pure, sterile, non-pyrogenic, and satisfy the United States Pharmacopeia (USP) standard for water for injection (WFI). Ideally, the device should be low powered, low cost, robust yet portable and deliver at least 10 liters per hour. Our design incorporated the purification methods of carbon filtration, reverse osmosis and Ultra-violet treatment. However, due to power and cost constraints our device was neither able to produce 10 liters per hour nor produce fluid sterile enough to satisfy USP 24 standards. Further improvements should include a more powerful pump for double pass reverse osmosis, more robust frame structure, portable power source and improved equipment sterilization technique

Faculty Recital, Rex Richardson, trumpet

Rex Richardson\u27s Trumpet Spectacular Magdalena Adamek, pianoTuesday, October 1, 2019 at 7pmSonia Vlahcevic Concert HallW.E. Singleton Center for the Performing Arts922 Park AvenueRichmond, Va.WithJeff Hudson, tubaKevin Maloney, trumpetTabatha Easley, fluteTaylor Barnett, trumpetRussell Wilson, pian

The effect of obesity upon Health Related Quality of Life (HRQoL): A comparison of the AQoL-8D and SF-36 instruments

OBJECTIVES: The objective of this study was to describe and measure the loss of health related quality of life (HRQoL) associated with obesity using two generic instruments. The first of these, the SF-36, is the most widely used and validated HRQoL instrument worldwide. However, it does not provide utility weights and cannot be used to measure quality adjusted life years (QALYs), an increasingly common unit for comparing the effect of health states in economic evaluation studies. The second, the AQoL-8D, is a multi-attribute utility (MAU) instrument which was developed to increase sensitivity of previous MAU instruments to psycho-social dimensions of a health state and to allow the calculation of QALYs. Since the two instruments differ, an important additional objective of the study was to determine the validity of the AQoL-8D as judged by the SF-36, and therefore the confidence which might be placed upon its use in the context of obesity.METHODS: Data were obtained from patients waiting for bariatric surgery who had completed both the SF-36 and AQoL-8D quality of life instruments and a general questionnaire including height, weight, demographic and socio-economic information. For comparative purposes, scores were standardized using results from a representative sample of the general population. The content validity of the AQoL-8D was assessed by comparing it with the dimension scores from the SF-36 and the summary component (physical and mental) scores. Overall scores from the SF-36 and AQoL-8D instruments were regressed upon patient BMI and the results from the AQoL-8D used to estimate the effect of overweight and obesity upon utility and lost QALYs.RESULTS: The comparison of the instruments indicated that the AQoL-8D has good convergent, concurrent and content validity. Using both instruments, obesity was significantly associated with lower scores for 14 of their 16 dimensions. AQoL-8D, in particular, identified a significant decrease in psychological and social health with happiness, self-worth, coping and mental health, all being poorer than in the control group. Regression results implied that a change in BMI from 30 to 50 decreases utility by 0.12 or by 13.8 percent of the average utility for a 25-35 year old.CONCLUSION: AQoL-8D is a valid measure of utility in the context of obesity. Its inclusion of psycho-social effects significantly increases the measured adverse effects of obesity

Chamber Brass Ensembles

Chamber Brass Ensemblescoached by Rex Richardson, Ross Walter, Jeff Hudson, Kevin MaloneyWednesday, April 3, 2019 at 8pmSonia Vlahcevic Concert Hall / W.E. Singleton Center for the Performing Arts922 Park Avenue / Richmond, Va

How Much Should We Spend on Health Services

This paper considers five questions relating to the cost of health services. These are: (1) What is causing the growth of health care expenditures? (2) Why do we limit resource use in health care? (3) How much should we spend on health services? (4) What is the value of a human life? (5) What are the equity and ethical issues which must be resolved before a satisfactory answer to the fourth question can be given? The paper concludes that there are no satisfactory answers to these questions and even the importance of the ethical questions is often not recognised