Cited by 751Health Systems, Economic Evaluations, Quality of LifeMedical Practices and RehabilitationEconomic and Environmental Valuation

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The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies

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Furlong, William J, Feeny, David H, Torrance, George W, Barr, Ronald D·2001·Annals of Medicine

DOI 10.3109/07853890109002092

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Abstract

This paper reviews the Health Utilities Index (HUI) systems as means to describe health status and obtain utility scores reflecting health-related quality of life (HRQoL). The HUI Mark 2 (HUI2) and Mark 3 (HUI3) classification and scoring systems are described. The methods used to estimate multiattribute utility functions for HUI2 and HUI3 are reviewed. The use of HUI in clinical studies for a wide variety of conditions in a large number of countries is illustrated. HUI provides a comprehensive description of the health status of subjects in clinical studies. HUI has been shown to be a reliable, responsive and valid measure in a wide variety of clinical studies. Utility scores provide an overall assessment of the HRQoL of patients. Utility scores are also useful in cost-utility analyses and related studies. General population norm data are available. The widespread use of HUI facilitates the interpretation of results and permits comparisons. HUI is a useful tool for assessing health status and HRQoL in clinical studies.

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Adler, F. R., Aurora, P., Barker, D., Barr, M. L., Blackwell, L. S., Bosma, O. H., Brown, S. M., Cox, D., Jensen, J. L., Kurland, G., et al. (2009) · Proceedings of the American Thoracic Society · doi:10.1513/pats.2009008-088tl · Cited by 110
What constitutes health‐related quality of life in dementia? Development of a conceptual framework for people with dementia and their carers
Smith, S. C., Murray, J., Banerjee, S., Foley, B. E., Cook, J. C., Lamping, D. L., Prince, M. J., Harwood, R., Levin, E., & MANN, A. H. (2005) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1374 · Cited by 109
“Pain, energy, independence, environment and spirituality have all also been included as dimensions of HRQL and health status (Ware et al., 1994; Furlong et al., 2001; EUROQOL Group, 1990; WHOQOL Group, 1996).”
Background
Health utility estimation
Torrance, G. W., Furlong, W. J., & Feeny, D. H. (2002) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/14737167.2.2.99 · Cited by 109
Self-citation
Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy – Results of a United Kingdom phase II trial (CNS 2007 04)
Bailey, S., Howman, A. J., Wheatley, K., Wherton, D., Boota, N., Pizer, B. L., Fisher, D., Kearns, P. R., Picton, S. V., Saran, F. H., et al. (2013) · European Journal of Cancer · doi:10.1016/j.ejca.2013.08.006 · Cited by 110
“The health utilities index (HUI) [25] and strengths and difficulties questionnaire (SDQ) [26] were used.”
Method
A Nurse-coordinated Model of Care versus Usual Care for Stage 3/4 Chronic Kidney Disease in the Community
Barrett, B. J., Garg, A. X., Goeree, R. A., Levin, A., Molzahn, A. E., Rigatto, C., Singer, J., Soltys, G., Soroka, S. D., Ayers, D., et al. (2011) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.07160810 · Cited by 108
“05 Diastolic BP 80 mmHg 40 (17) 60 (26) 0.”
Method
A comparison of doctors', parents' and children's reports of health states and health‐related quality of life in children with chronic conditions
Morrow, A., Hayen, A. D., Quine, S., Scheinberg, A. M., & Craig, J. C. (2011) · Child Care Health and Development · doi:10.1111/j.1365-2214.2011.01240.x · Cited by 104
Predictors of Health Utility among 60-Day Survivors of Acute Kidney Injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study
Johansen, K. L., Smith, M. W., Unruh, M. L., Siroka, A. M., O’Connor, T., & Palevsky, P. M. (2010) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.02570310 · Cited by 102
“Health utility following AKI in the ICU requiring RRT in the ATN study was extremely low by any metric, given that 27% of respondents’ health states corresponded to utilities considered by the general population to be equivalent to or worse than death.”
BackgroundMethodInfluential
The impact of diabetic retinopathy and diabetic macular edema on health-related quality of life in type 1 and type 2 diabetes
Fenwick, E. K., Xie, J., Ratcliffe, J., Pesudovs, K., Finger, R. P., Wong, T. Y., & Lamoureux, E. L. (2012) · Investigative Opthalmology & Visual Science · doi:10.1167/iovs.11-8992 · Cited by 101
Comparing directly measured standard gamble scores to HUI2 and HUI3 utility scores: group- and individual-level comparisons.
Feeny, D., Furlong, W., Saigal, S., & Sun, J. (2004) · Social Science & Medicine (1967) · doi:10.1016/s0277-9536(03)00254-5 · Cited by 106
Self-citation
Cochlear Implant Rehabilitation in Older Adults: Literature Review and Proposal of a Conceptual Framework
Clark, J. H., Yeagle, J. D., Arbaje, A. I., Lin, F. R., Niparko, J. K., & Francis, H. W. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04150.x · Cited by 100
“Health-related quality of life (HRQoL) measures, by comparison, assess a person’s overall well-being and quantify the extent to which an intervention is found to be more or less useful than another.(18) Increasing demand for evidence-based and cost-effective health care necessitates careful characterization of auditor…”
Background
Age, SES, and health: a population level analysis of health inequalities over the lifecourse.
Prus, S. G. (2007) · Sociology of Health and Illness · doi:10.1111/j.1467-9566.2007.00547.x · Cited by 114
The impact of diabetic retinopathy: understanding the patient's perspective
Fenwick, E., Pesudovs, K., Rees, G., Dirani, M., Kawasaki, R., Wong, T. Y., & Lamoureux, E. L. (2010) · British Journal of Ophthalmology · doi:10.1136/bjo.2010.191312 · Cited by 98
Predicting EuroQoL EQ-5D Preference Scores from the SF-12 Health Survey in a Nationally Representative Sample
Lawrence, W., & Fleishman, J. A. (2004) · Medical Decision Making · doi:10.1177/0272989x04264015 · Cited by 95
The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients
Mondor, L., Maxwell, C. J., Bronskill, S. E., Gruneir, A., & Wodchis, W. P. (2016) · Quality of Life Research · doi:10.1007/s11136-016-1281-y · Cited by 97
Health status and health‐related quality of life associated with hemophilia
Barr, R. D., Saleh, M., Furlong, W. J., Horsman, J., Sek, J., Pai, M., & Walker, I. (2002) · American Journal of Hematology · doi:10.1002/ajh.10191 · Cited by 97
“These data mirror and extend those reported recently by others [27,28], and are compared with data from other groups of patients in Table IX as we have reported recently [29,30].”
ResultSelf-citation
Participation of young severely disabled children is influenced by their intrinsic impairments and environment
Forsyth, R. J., Colver, A. F., Alvanides, S., Woolley, M., & Lowe, M. (2007) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2007.00345.x · Cited by 97
Measurement of Quality of Life of Survivors of Neonatal Intensive Care: Critique and Implications
Saigal, S., & Tyson, J. E. (2008) · Seminars in Perinatology · doi:10.1053/j.semperi.2007.12.007 · Cited by 96
Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA): A model for sustainable development in pediatric oncology
Barr, R. D., Antillón‐Klussmann, F., Báez, F., Bonilla, M., Moreno, B., Navarrete, M., Nieves, R. M., Peña, A., Conter, V., de Alarcón, P. A., et al. (2013) · Pediatric Blood & Cancer · doi:10.1002/pbc.24802 · Cited by 95
Self-citation
Health‐related quality of life among children with acute lymphoblastic leukemia
Furlong, W. J., Rae, C. S., Feeny, D. H., Gelber, R. D., Laverdière, C., Michon, B., Silverman, L. B., Sallan, S. E., & Barr, R. D. (2012) · Pediatric Blood & Cancer · doi:10.1002/pbc.24096 · Cited by 95
Self-citation
Proficiency of Balance in Children and Youth Who Have Had Acute Lymphoblastic Leukemia
Wright, M. J., Galea, V., & Barr, R. D. (2005) · Physical Therapy · doi:10.1093/ptj/85.8.782 · Cited by 95
Self-citation
Construction of the Patient-Oriented Prostate Utility Scale (PORPUS)
Krahn, M. D., Ritvo, P., Irvine, J., TOMLINSON, G. A., Bezjak, A., Trachtenberg, J., & Naglie, G. (2000) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00211-0 · Cited by 94
Quality of life after intervention with a cochlear implant or hearing aid
Contrera, K. J., Betz, J., Li, L., Blake, C. R., Sung, Y. K., Choi, J. S., & Lin, F. R. (2016) · The Laryngoscope · doi:10.1002/lary.25848 · Cited by 92
Development, reliability and validity of a new measure of overall health for pre-school children
Saigal, S., Rosenbaum, P., Stoskopf, B. L., Hoult, L., Furlong, W. J., Feeny, D. F., & Hagan, R. (2005) · Quality of Life Research · doi:10.1007/s11136-004-4228-7 · Cited by 92
“However, despite the promising use of HUI for describing the health status of school-aged children and adolescents [3, 4, 9–13], we and others have had difficulty applying it to pre-school children as the dimension levels were designed for school-aged children to adulthood [14, 15] (e.”
MethodSelf-citation
The predictive validity of health-related quality of life measures: mortality in a longitudinal population-based study
Kaplan, M. S., Berthelot, J., Feeny, D. H., McFarland, B. H., Khan, S., & Orpana, H. (2007) · Quality of Life Research · doi:10.1007/s11136-007-9256-7 · Cited by 92
Self-citation
Estimating distributions of health state severity for the global burden of disease study
Burstein, R., Fleming, T., Haagsma, J. A., Salomon, J. A., Vos, T., & Murray, C. J. L. (2015) · Population Health Metrics · doi:10.1186/s12963-015-0064-y · Cited by 93
“Second, where functional health status data have been collected, many different instruments have been used such as EQ-5D [9], the 12-item Short Form (SF-12) [10], the Health Utilities Index [11], the Assessment of Quality of Life [12] or a multitude of other disease-specific quality of life and functioning instruments.”
Method
Participation in childhood
Forsyth, R. J., & Jarvis, S. (2002) · Child Care Health and Development · doi:10.1046/j.1365-2214.2002.00272.x · Cited by 92
Impact of Age, Sex, Physical Function, Health-related Quality of Life, and Treatment with Adalimumab on Work Status and Work Productivity of Patients with Ankylosing Spondylitis
Maksymowych, W. P., Gooch, K. L., Wong, R. L., Küpper, H., & van der Heijde, D. M. F. M. (2009) · The Journal of Rheumatology · doi:10.3899/jrheum.090242 · Cited by 91
Evaluating the discriminatory power of EQ-5D, HUI2 and HUI3 in a US general population survey using Shannon’s indices
Janssen, M. F., Birnie, E., & Bonsel, G. J. (2007) · Quality of Life Research · doi:10.1007/s11136-006-9160-6 · Cited by 89
“All three instruments have shown acceptable psychometric properties as established by conventional measures [8, 9].”
Background
Osteopenia, physical activity and health‐related quality of life in survivors of brain tumors treated in childhood
Odame, I., Duckworth, J., Talsma, D., Beaumont, L. F., Furlong, W. J., Webber, C. E., & Barr, R. D. (2005) · Pediatric Blood & Cancer · doi:10.1002/pbc.20512 · Cited by 88
“The information from the questionnaires was converted to health-status classification system attribute levels of the HUI Mark 2 (HUI2) and Mark 3 (HUI3) according to established algorithms [24].”
MethodSelf-citation
Estimating the burden of disease in chronic pain with and without neuropathic characteristics: Does the choice between the EQ-5D and SF-6D matter?
Torrance, N., Lawson, K. D., Afolabi, E. K., Bennett, M., Serpell, M. G., Dunn, K. M., & Smith, B. H. (2014) · Pain · doi:10.1016/j.pain.2014.07.001 · Cited by 86
“There are a number of utility instruments [9,18,19] commonly used in clinical practice and research.”
Background
Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review
Dawes, P., Wolski, L., Himmelsbach, I., Regan, J. L., & Leroi, I. (2018) · International Psychogeriatrics · doi:10.1017/s1041610218000728 · Cited by 87
Health status and health‐related quality of life associated with von Willebrand disease
Barr, R. D., Sek, J., Horsman, J., Furlong, W. J., Saleh, M., Pai, M., & Walker, I. (2003) · American Journal of Hematology · doi:10.1002/ajh.10327 · Cited by 86
Self-citation
Estimating the SF-6D Value Set for a Population-Based Sample of Brazilians
Cruz, L. N., Camey, S. A., Hoffmann, J. F., Rowen, D., Brazier, J. E., Fleck, M. P., & Polanczyk, C. A. (2011) · Value in Health · doi:10.1016/j.jval.2011.05.012 · Cited by 86
“[6] Furlong WJ, Feeny DH, Torrance GW, Barr RD.”
BackgroundMethod
Health-related Quality of Life Outcomes of Adalimumab for Patients with Early Rheumatoid Arthritis: Results from a Randomized Multicenter Study
Strand, V., Rentz, A. M., Cifaldi, M. A., Chen, N., Roy, S., & Revicki, D. A. (2011) · The Journal of Rheumatology · doi:10.3899/jrheum.101161 · Cited by 85
The Initiating Dialysis Early and Late (Ideal) Study: Study Rationale and Design
Cooper, B. A., Branley, P., Bulfone, L., Collins, J. F., Craig, J. C., Dempster, J., Fraenkel, M. B., Harris, A., Harris, D. C. H., Johnson, D. W., et al. (2004) · Peritoneal Dialysis International · doi:10.1177/089686080402400209 · Cited by 85
“Quality of life will be measured using the following instruments: Assessment of Quality of Life (AQoL) (19), Health Utilities Index III (HUI III) (20), and the Kidney Disease and Quality of Life Short Form (KDQOL-SF) (21).”
Method
Evaluation of a revised indication for determining adult cochlear implant candidacy
Sladen, D. P., Gifford, R. H., Haynes, D. S., Kelsall, D. C., Benson, A. G., Lewis, K., Zwolan, T. A., Fu, Q., Gantz, B. J., Gilden, J., et al. (2017) · The Laryngoscope · doi:10.1002/lary.26513 · Cited by 85
Clinical utility of genomic sequencing: a measurement toolkit
Hayeems, R. Z., Dimmock, D., Bick, D. P., Belmont, J. W., Green, R. C., Lanpher, B. C., Jobanputra, V., Mendoza‐Londono, R., Kulkarni, S., Grove, M. E., et al. (2020) · npj Genomic Medicine · doi:10.1038/s41525-020-00164-7 · Cited by 92
Quality of life in survivors of childhood cancer: a systematic review of the literature (2001–2008)
McDougall, J., & Tsonis, M. (2009) · Supportive Care in Cancer · doi:10.1007/s00520-009-0660-0 · Cited by 115
“The remaining seven measures were used to assess HRQL and included: the KIDSCREEN [44], the Health Utilities Index (HUI) system, specifically the HUI2 and the HUI3 [45], the RAND-36 [46], the Child Health Questionnaire (CHQ) [47], the Minneapolis–Manchester Quality of Life—Youth Form (MMQL-YF) [48], and the Nottingham…”
Method
Long‐term utility outcomes in patients undergoing endoscopic sinus surgery
Rudmik, L. R., Mace, J. C., Soler, Z. M., & Smith, T. L. (2013) · The Laryngoscope · doi:10.1002/lary.24135 · Cited by 83

Authors: Furlong, W. J., Feeny, D. H., Torrance, G. W., & Barr, R. D.
Affiliations: McMaster University (CA)
Corresponding author: Furlong, William J
ORCID: Furlong, William J
Feeny, David H
Barr, Ronald D
Venue: Annals of Medicine
Publisher: Informa UK Limited
Published: 2001-01
Volume: 33
Issue: 5
Pages: 375-384
ISSN: 0785-3890 (ISSN-L)
1365-2060
DOI: 10.3109/07853890109002092
OpenAlex: W2015583354
Cited by: 751
References: 79
Citations by year: 2026: 21 · 2025: 23 · 2024: 32 · 2023: 21 · 2022: 26 · 2021: 21 · 2020: 27 · 2019: 14 · 2018: 37 · 2017: 32 · 2016: 27 · 2015: 29 · 2014: 38 · 2013: 40 · 2012: 40
FWCI: 8.60
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Annals of Medicine (publishedVersion)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
MacSphere (McMaster University) (submittedVersion)
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
Keywords: Health Utilities Index, Health Utilities Index Mark 3, health-related quality of life, health status measurement, utility scores, multi-attribute utility function, cost-utility analysis, reference values, clinical trials
MeSH terms: Cost-Benefit Analysis, Cross-Sectional Studies, Health Status, Humans, Longitudinal Studies, Quality of Life, Reference Standards, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care

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The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies

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