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A comparison of health utility measures for the evaluation of multiple sclerosis treatments
  1. J D Fisk1,2,3,
  2. M G Brown3,4,5,
  3. I S Sketris4,5,
  4. L M Metz6,
  5. T J Murray1,4,
  6. K J Stadnyk3
  1. 1Department of Medicine, Dalhousie University, Halifax, NS, Canada
  2. 2Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
  3. 3Capital District Health Authority, Halifax, NS, Canada
  4. 4Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
  5. 5College of Pharmacy, Dalhousie University, Halifax, NS, Canada
  6. 6Department of Clinical Neurological Sciences, University of Calgary, Calgary, AB, Canada
  1. Correspondence to:
 Dr J Fisk
 Abbie J. Lane Building, Queen Elizabeth II Health Sciences Centre, Veterans Memorial Lane, Halifax, NS, B3H 2E3;


Objectives: To evaluate the practical application and psychometric properties of three health utility measures in a sample of MS patients with a broad range of neurological disability as measured by the Extended Disability Status Scale (EDSS).

Methods: Patients randomly selected from two MS clinic registries were assessed using standard clinical methods and completed three generic measures of health utility (EQ-5D, HUI Mark III, SF-6D). The proportion of missing data, test/retest reliability, and construct validity of each health utility measure were examined.

Results: The assessments were completed by 187 patients. Less than 10% of data were missing for the subscales of the SF-6D (<3.2%), HUI Mark III (<1.6%), and EQ-5D (⩽7.5%). Severely disabled patients were more likely to omit physical function questions for the SF-6D (20%), and EQ-5D (43%). Retest reliability for the SF-6D (ICC = 0.83), EQ-5D (ICC = 0.81), and HUI Mark III (ICC = 0.87) were adequate for population surveys. Correlations between assessment of clinical function and each health utility measure were strongest for the HUI Mark III (HUI Mark III EDSS ρ = −0.77, HUI Mark III ambulation index ρ = −0.76, HUI Mark III timed 25 foot walk ρ = −0.73, HUI Mark III nine hole peg test ρ = −0.65).

Conclusions: The health utility measures were generally feasible and reliable but the HUI Mark III demonstrated highest concordance with the EDSS across the full range of neurological disability. Of the three measures studied, the HUI Mark III may be the most appropriate for cost effectiveness evaluations of MS therapies.

  • EDSS, Extended Disability Status Scale
  • HRQoL, health related quality of life
  • MS, multiple sclerosis
  • HUI Mark III, Health Utilities Index Mark III
  • QALY, quality adjusted life year
  • SF-36, Medical Outcomes Study Short Form 36
  • multiple sclerosis
  • quality of life
  • health utility measures

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  • Competing interests: none declared