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The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies
Open accessAbstract
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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“The Health Utilities Index (HUI) provides indicators of multiple attributes of health status for use in economic evaluations of healthcare programmes. It has well-established validity and reliability in many clinical contexts (test–retest reliability of 0.767 intraclass correlation coefficient).77 78”
From Coached, Coordinated, Enhanced Neonatal Transition (CCENT): Protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants (2021) · cites this paper as [77]
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“In addition, the children’s HRQoL was measured using the HUI (parental proxy).”
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“The Health Utilities Index–2 is a family of brief generic health status instruments that yield utilities (ie, single values representing health status on a scale in which 1 = perfect health and 0 = death) that can be used to represent health-related quality of life in cost-utility models.(34,35) The Health Utilities I…”
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“For instance, Barr et al. (32) and Furlong et al. ( 39 ) provided evidence on the responsiveness of HUI2 and”
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“The pain attribute has five levels ranging from ‘no pain’ to ‘severe pain that prevents most activities’.(17) The HUI3 pain attribute was selected because it provides a salient interpretation of a subjective individualized experience of pain.”
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“) The Health Utilities Index-III (HUI-III) a 15-item, 8-attribute generic health state preference instrument, provides a valuation of health state ranging from 0 = death to 1 = perfect health.(18,19) The HUI-III has demonstrated validity (construct, discriminant, construct), test–retest reliability, and responsiveness…”
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“The HUI-2 has been commonly used because it includes a general health profile and preference-based health measures, has been validated across many health conditions, has been translated into several languages, and is useful in cost-utility economic evaluations.(7,8) The HUI-2 can measure effects of comorbidities and c…”
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“The HUI-2 allows for the translation of any individual (multidimensional) health state into a utility score that estimates the relative societal preference for that state [24].”
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“Commonly used generic utility measures include the EQ-5D [37], the Quality of Well-Being scale [38], and the Health Utility Index [39, 40].”
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“Secondary outcomes included any of the following self-reported outcomes: (i) General healthrelated QoL (e.g. Health Utilities Index Mark 3: Furlong et al. 2001); (ii) listening ability (e.g. Abbreviated Profile of Hearing Aid Benefit: Cox and Alexander 1995); (iii) cognition (e.g. working memory);…”
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“36 and 1 represent the utilities of the worst and best possible HUI3 health states, respectively; and 0 represents death [22].”
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“The HUI3 Classification System was designed to have full structural independence.(8) Thus, a child who is blind may have normal ambulatory abilities, even though navigation may be affected.”
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Self-reported chronic conditions and EQ‐5D index scores in the US adult population
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Health status and health-related quality of life in adolescent survivors of cancer in childhood
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BackgroundMethodInfluentialSelf-citationQuality of life and rare diseases.
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“In the case of the hydrocephalus study, Health Utility Index (HUI-2) [ 21 , 61] scores were also collected from the mothers, making it possible to compare scores in those children with those of children included in other studies using the same instrument.”
ResultSung, L., Greenberg, M., Doyle, J., Young, N. L., Ingber, S., Rubenstein, J., Wong, J., Samanta, T., McLimont, M., & Feldman, B. M. (2003) · British Journal of Cancer · doi:10.1038/sj.bjc.6600895 · Cited by 53
“The start and stop times for completing each of the instruments were also recorded.”
BackgroundMethodInfluentialPopulation norms for the EQ-5D-3L in China derived from the 2013 National Health Services Survey
Yao, Q., Liu, C., Zhang, Y., & Xu, L. (2021) · Journal of Global Health · doi:10.7189/jogh.11.08001 · Cited by 53
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“Measures of quality of life may include the Health Utilities Index (Furlong et al. 2001) and the Cochlear Implant Quality of Life (CIQOL) CIQOL-35 Profile and CIQOL-10 Global (McRackan et al. 2019).”
BackgroundEaton, L. H., Langford, D. J., Meins, A. R., Rue, T., Tauben, D. J., & Doorenbos, A. Z. (2018) · Pain Management Nursing · doi:10.1016/j.pmn.2017.09.004 · Cited by 49
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de Jongh, M. A. C., Kruithof, N., Gosens, T., van de Ree, C. L. P., de Munter, L., Brouwers, L., Polinder, S., Lansink, K. W. W., & BIOS-group (2016) · Injury Prevention · doi:10.1136/injuryprev-2016-042032 · Cited by 50
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Newbold, K. B., & Filice, J. (2006) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1353/cja.2007.0009 · Cited by 49
“Since each of the eight attributes contains five or six levels, HUI3 scores can represent 972,000 unique health states, clearly allowing for greater variation than self-reported health (Furlong et al., 2001).”
BackgroundMeasuring health-related quality of life for child maltreatment: a systematic literature review
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“Currently available preference-based QOL instruments (EQ-5D, HUI, QWB, SF-6D) have been developed primarily for adults with the exception of the Health Utilities Index.”
InfluentialDakin, H., Petrou, S., Haggard, M. P., Benge, S., & Williamson, I. G. (2009) · Quality of Life Research · doi:10.1007/s11136-009-9558-z · Cited by 48
“HUI3 is now recommended in preference to HUI2 due to its broad applicability, greater structural independence and improved health state definitions [40, 47].”
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“Quality of life was measured using the health utility index-mark III (HUI) [17] and self-perception profile for children (SPPC) [24, 38].”
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Integrating Mortality and Morbidity Outcomes
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“We selected two validated parent-completed questionnaires, theHealth Utilities Index (HUI) [21] and the Child Development Inventory (CDI) [22] from available paediatric developmental assessment tools, purchasing licenses for the use and exact reproduction of each questionnaire.”
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“The HUI3 assessment relies on the preferences of the Canadian general population, which could be different from the preferences of elderly patients with heart disease who participated in the MADIT-II study.”
MethodInfluentialHyperprolactinemia in End-Stage Renal Disease and Effects of Frequent Hemodialysis
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Is Health-Related Quality of Life Improving After Stroke?
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Natural health product use in Canada: analysis of the National Population Health Survey.
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Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario
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“0 represents the best possible health one could expect to achieve [20–23].”
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The Role of Age on Cochlear Implant Performance, Use, and Health Utility
Zwolan, T. A., Henion, K., Segel, P., & Runge, C. L. (2014) · Otology & Neurotology · doi:10.1097/mao.0000000000000583 · Cited by 45
“All subjects completed the HUI-3 questionnaire preimplant and 6 and 12 months postimplant.”
Background
Metadata
- Authors
- Furlong, W. J., Feeny, D. H., Torrance, G. W., & Barr, R. D.
- Affiliations
- McMaster University (CA)
- Corresponding author
- Furlong, William J
- 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
- 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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