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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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Giesbrecht, E., & Miller, W. C. (2017) · PeerJ · doi:10.7717/peerj.3879 · Cited by 17
“Given the encouraging results and minimal administration burden, the HUI can be included as an outcome in subsequent trials to measure health-related quality of life and potentially evaluate cost-effectiveness (Furlong et al., 2001; Horsman et al., 2003).”
BackgroundWolfenstetter, S. B. (2011) · Prevention Science · doi:10.1007/s11121-011-0235-4 · Cited by 17
“Generic quality of life instruments such as the EuroQuol-5 Dimensions (Greiner et al. 2003), Health Utility Index (Furlong et al. 2001), SF-36 or SF-6D Health Survey (Brazier et al. 1992, 2002; Brazier and Roberts 2004; Ellert and Kurth 2004; Scott et al. 2000; Ware et al. 1998), among others,…”
MethodHealth-Related Quality of Life
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Self-citationSwan, J. S., Ying, J., Stahl, J. E., Kong, C. Y., Moy, B., Roy, J., & Halpern, E. F. (2010) · Quality of Life Research · doi:10.1007/s11136-010-9587-7 · Cited by 16
“Thus, the plan for construction of attributes and items is based on the assumption of building an alg braic multiattribute utility model [27] as opposed to a statistical one (e.”
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Kharroubi, S. A., Beyh, Y. S., Diab-El-Harake, M., Dawoud, D., Rowen, D., & Brazier, J. E. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17031037 · Cited by 17
Health-related quality of life of pediatric intensive care survivors
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“HUI3 global score 85 (40) 45 (21) 80 (38) 0.”
A systematic literature review of cardiovascular event utilities
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“Additional tools such as the patient-administered, preference-based Health Utilities Index Mark 2 and Mark 3 have also been used in clinical studies for a wide variety of conditions to provide a comprehensive description of health status and obtain utility scores reflecting HRQoL [88].”
Kruyt, I. J., Monksfield, P., Skarzynski, P. H., Green, K. M. J., Runge, C. L., Bosman, A. J., Blechert, J. I., Wigren, S., Mylanus, E. A. M., & Hol, M. K. S. (2020) · Otology & Neurotology · doi:10.1097/mao.0000000000002689 · Cited by 16
“Patient-reported outcomes were measured using the healthrelated quality of life (HRQoL) questionnaire Health Utilities Index (HUI3) (12) as well as the hearing specific questionnaires Abbreviated Profile of Hearing Aid Benefit (APHAB) (13), and Speech, Spatial, and Qualities of Hearing Scale (SSQ) (14).”
MethodInfluentialTapering Off Benzodiazepines in Long-Term Users
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Health-related quality of life (HRQoL) domains most valued by urban isiXhosa-speaking people
Jelsma, J. M., Mkoka, S., & Amosun, S. L. (2007) · Quality of Life Research · doi:10.1007/s11136-007-9283-4 · Cited by 16
“Utilities Index 2(HUI-2) [22] and the SF-36 [23], which raises the "ceiling" of the instrument but includes activities that might not be highly valued.”
BackgroundBull, K., Hornsey, S., Kennedy, C., Darlington, A., Grootenhuis, M. A., Hargrave, D. R., Liossi, C., Shepherd, J. P., Walker, D. A., & Morris, C. (2019) · Neuro-Oncology Practice · doi:10.1093/nop/npz064 · Cited by 15
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“…component is typically confined to health-related quality of life (HRQoL), measured by generic instruments such as the EuroQol instrument (EQ-5D) (EuroQol Group, 1990), the Short-Form Health Survey (SF-36) (Ware & Sherbourne, 1992) or the Health Utilities Index (HUI) (Furlong et al., 2001).”
Reaume, S. V., Dubin, J. A., Perlman, C. M., & Ferro, M. A. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241271713 · Cited by 15
Establishing disability weights from pairwise comparisons for a US burden of disease study
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Cost Effectiveness Analysis for Nursing Research
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“First, it provides a comprehensive description of health status that has been shown to be responsive to changes in health over time (Barr et al., 1997; Furlong et al., 2001; Blanchard et al., 2003).”
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Self-citationNathan, P. C., Furlong, W. J., Horsman, J., schaik, C. V., Rolland, M., Weitzman, S. S., Feeny, D. H., & Barr, R. D. (2004) · Quality of Life Research · doi:10.1007/s11136-004-7624-0 · Cited by 15
“Improvement of the scoring system for the CHSCS-PS should include use of utility-based measurements to create a multi-attribute utility function similar to those available for the HUI2 and HUI3 [ 21 ].”
MethodSelf-citationKlok, R. M., Arents, N. L. A., de Vries, R., Thijs, J. C., Brouwers, J. R. B. J., Kleibeuker, J. H., & Postma, M. J. (2005) · Clinical Therapeutics · doi:10.1016/j.clinthera.2005.10.011 · Cited by 15
Davison, S. N., Jhangri, G. S., & Feeny, D. H. (2008) · Quality of Life Research · doi:10.1007/s11136-008-9354-1 · Cited by 14
“The Health Utilities Index (HUI) is a family of generic multi-attribute preference-based HRQL instruments [11, 12].”
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“The HRQL reported in this study was measured using the HUI2, which consists of seven attributes (domains): sensation (vision, hearing and speech), mobility, emotion, cognition, selfcare, pain and fertility [6, 18, 19].”
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“HUI are generic, multiattribute, preference-based measures developed at McMaster University with established validity and reliability.[6] Proxy responses are elicited for children 5 years of age.”
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Smith, A. B., Cocks, K., Parry, D., & Taylor, M. J. (2016) · Value in Health · doi:10.1016/j.jval.2016.06.005 · Cited by 14
How Robust Is the Health Utilities Index Mark 2 Utility Function?
Wang, Q., Furlong, W. J., Feeny, D. F., Torrance, G. W., & Barr, R. D. (2002) · Medical Decision Making · doi:10.1177/027298902400448911 · Cited by 14
Self-citationEconomic evaluation and health-related quality of life
Calaminus, G., & Barr, R. D. (2008) · Pediatric Blood & Cancer · doi:10.1002/pbc.21456 · Cited by 14
“Studies in Australia [23], Canada [13], and the United Kingdom [24] have used the Child Health Questionnaire [25], the Health Utilities Index [26] and the Short Form 36 [27], respectively.”
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Kulkarni, A. V. (2006) · Developmental Medicine & Child Neurology · doi:10.1017/s0012162206000247 · Cited by 14
“…social–emotional difficulties; the Wide Range Achievement Reading Test (Wilkinson 1993), a measure of cognitive health; the Health Utilities Index–2 (Furlong et al. 2001), a measure of overall health; and the Impact-on-Family Scale (Stein and Riessman 1980), a measure of the impact of a child’s…”
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Saiguay, W., & Sakthong, P. (2012) · Quality of Life Research · doi:10.1007/s11136-012-0297-1 · Cited by 13
“The HEALTH UTILITIES INDEX (HUI ) is one of the most widely used utility measures [9] that has been shown good psychometric properties in the patients with W.”
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Frick, U., Irving, H. M., & Rehm, J. T. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9945-0 · Cited by 14
“In addition, about 15% of the 389 health states used were construed by workshop participants representing their respective area of Table 1 Major instruments to measure health-related quality of life and disability Instrument Reference Abbreviation Social relationships Operationalization Health Utilities Index Mark III…”
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“Health Utilities Index (Mark II/III) The HUI is a family of multiattribute health status classification systems that currently consists of two complementary systems: HUI2 and HUI3 [12].”
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Nathan, P. C., Furlong, W. J., Pauw, S. D., Horsman, J., Schaik, C. V., Rolland, M., Weitzman, S. S., Feeny, D. H., & Barr, R. D. (2004) · Pediatric Blood & Cancer · doi:10.1002/pbc.20133 · Cited by 13
“In order to facilitate such analyses, the CHSCS-PS should be enhanced with a utility-based HRQL scoring system similar to the multi-attribute utility functions for the HUI2 and HUI3 [10].”
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“Respondents filled in the descriptive systems of AQoL-8D [17], EQ5D-5L [18], HUI 3 [19], and SF-36v2 to derive SF-6D [20], and the 15D [2].”
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“Health Utilities Index has become the instrument of choice for cost-utility analyses by many health economists.[5,25,26] However, rather than having any specific preference for utility measures, pharmaceutical companies in the past have tended to use the Health Utilities Index for cost-utility analyses in North Americ…”
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“questionnaires including the EuroQol [28–30] and the HUI [18–20].”
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“The change in the utility score, recognized as utility gain, met the requirements of the published guidelines for the economic evaluation of pharmaceutical and health-care services [12].”
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Khan, S. A., Khan, M. F., Bakhshi, S. K., Irfan, O., Khan, H. A. R., Abbas, A., Awan, S., & Bari, M. E. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.01.107 · Cited by 11
Tan, E. J., Brown, V., Petrou, S., D'Souza, M. I., Moodie, M., Wen, L. M., Baur, L. A., Rissel, C. E., & Hayes, A. (2018) · Quality of Life Research · doi:10.1007/s11136-018-1932-2 · Cited by 11
Thoma, A., Kaur, M. N., Ignacy, T. A., Levis, C. M., Martin, S., Duku, E., & Haines, T. (2014) · Hand · doi:10.1007/s11552-013-9597-3 · Cited by 11
“[1 5, 16 ,2 2] 8; vi si on ,h ea ri ng ,s pe ec h,”
A cost-utility analysis of treatments for malignant liver tumours: a pilot project
McKay, A. M., Kutnikoff, T., & Taylor, M. (2006) · HPB · doi:10.1080/13651820600994541 · Cited by 11
Commentary. In Praise of Studies That Use More Than One Generic Preference-Based Measure
Feeny, D. H., Furlong, W. J., & Torrance, G. W. (2019) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462319000412 · Cited by 11
Self-citationHealth and Income Across the Life Cycle and Generations in EuropePreprint
van Kippersluis, H., Ourti, T. V., O'Donnell, O. A., & van Doorslaer, E. K. A. (2008) · SSRN Electronic Journal · doi:10.2139/ssrn.1086587 · Cited by 11
Schneeweiß, S. (2009) · Value in Health · doi:10.1111/j.1524-4733.2009.00607.x · Cited by 11
The Validity and Reliability of Dichotomized Self-rated Health Under Different CutpointsPreprint
Plante, C., Missiuna, S., & Neudorf, C. O. (2024) · medRxiv · doi:10.1101/2024.04.18.24306035 · Cited by 11
“In this paper, we use the Health Utility Index Mark 3 (HUI) 12,13 to test the validity and reliability of different dichotomizations of self-rated health in three years of the CCHS.”
MethodQuantitative MRI distinguishes different leukodystrophies and correlates with clinical measures
Stellingwerff, M. D., Al‐Saady, M. L., Chan, K., Dvorak, A. V., Marques, J. P., Kolind, S., Schoenmakers, D. H., van Voorst, R. J., Roosendaal, S. D., Barkhof, F., et al. (2024) · European Radiology · doi:10.1007/s00330-024-11089-5 · Cited by 11
“The Health Utilities Index (HUI) estimates the level of functioning in daily life [13].”
Disparities in health utilities among hepatitis C patients receiving care in different settings
Saeed, Y. A., Mason, K., Mitsakakis, N., Feld, J. J., Bremner, K. E., Phoon, A., Fried, A., Wong, J. F., Powis, J. E., Krahn, M. D., et al. (2022) · Canadian Liver Journal · doi:10.3138/canlivj-2022-0009 · Cited by 10
Construct validity for the Health Utilities Index in a sleep center
Welch, K. C., & Scharf, S. M. (2007) · Sleep And Breathing · doi:10.1007/s11325-007-0111-4 · Cited by 10
“This is not surprising, as HUI2 and HUI3 have been designed to be complementary assessments and are based on the similar concepts [17].”
BackgroundDevelopment of Measurement Model for the Value of QOL as an Influential Factor of Metabolic Syndrome
Yang, J., & Lee, Y. (2014) · Wireless Personal Communications · doi:10.1007/s11277-014-1843-7 · Cited by 10
Távora‐Vieira, D., Marino, R., Acharya, A. N., & Rajan, G. P. (2016) · Cochlear Implants International · doi:10.1080/14670100.2016.1176303 · Cited by 10
“Quality of life was assessed using the Health Utilities Index 3 (HUI-3) (Furlong et al., 2001) in two studies.”
MethodLambriks, L., van Hoof, M., Debruyne, J. A., Janssen, A. M. L., Chalupper, J., van der Heijden, K., Hof, J. R., Hellingman, C. A., George, E. L. J., & Devocht, E. M. J. (2020) · Trials · doi:10.1186/s13063-020-04469-x · Cited by 10
Schölzel-Dorenbos, C. J. M., Krabbe, P. F. M., & Rikkert, M. G. M. O. (2009) · Springer eBooks · doi:10.1007/978-0-387-78665-0_213 · Cited by 10
Franic, D. M., Bothe, A. K., & Bramlett, R. E. (2012) · Journal of Fluency Disorders · doi:10.1016/j.jfludis.2012.04.005 · Cited by 10
Whitmer, W. M., Wright-Whyte, K., Holman, J. A., & Akeroyd, M. A. (2016) · Springer handbook of auditory research · doi:10.1007/978-3-319-33036-5_10 · Cited by 10
Impact of Diabetic Retinopathy on Health-related Quality of Life in Iranian Diabetics.
Alinia, C., Mohammadi, S.-F., Lashay, A., & Rashidian, A. (2017) · Europe PMC (PubMed Central) · Cited by 10
Bahrampour, M., Norman, R., Byrnes, J., Downes, M., & Scuffham, P. (2020) · Patient · doi:10.1007/s40271-020-00468-x · Cited by 10
“36 [36] and the value for the EQ-5D-3L for the Australian population using DCE is − 0.”
MethodLo, P. S. Y., Tong, M. C. F., Revicki, D. A., Lee, C. C., Woo, J. K. S., Lam, H. C. K., & van Hasselt, C. A. (2006) · Quality of Life Research · doi:10.1007/s11136-005-4828-x · Cited by 10
“Furlong and colleagues [23] examined the”
Population health impact of cancer in Canada, 2001.
Boswell-Purdy, J., Flanagan, W. M., Roberge, H., Petit, C. L., White, K. J., & Berthelot, J.-M. (2007) · PubMed · Cited by 10
The roles for preference-based measures in support of cancer research and policy
Feeny, D. H. (2004) · Cambridge University Press eBooks · doi:10.1017/cbo9780511545856.004 · Cited by 10
Self-citationQuality of life in home-dwelling cancer patients aged 80 years and older: a systematic review
Hjelmeland, I. H. H., Drageset, J., Nordvik, Ø., & Beisland, E. G. (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-022-02070-1 · Cited by 9
“A generic utility instrument, the Health Utilities Index (HUI2/3) [29], as well as a diagnosis-specific QoL instrument, the Functional Assessment of Cancer Therapy- Prostate (FACT-P) [30] was included in Krahn et al.”
MethodFernando-Canavan, L., Abraham, P., Devlin, N. J., & Tran‐Duy, A. (2023) · Quality of Life Research · doi:10.1007/s11136-023-03554-3 · Cited by 9
“Well-known preference-weighted instruments for measuring HRQoL in a manner that allows QALY estimation include EQ-5D [16], Health Utility Index Mark 2 (HUI2) and Mark 3 (HUI3) [17], and SF-6D [18].”
Kwon, J., Raghunandan, R., Nghiem, S. H., Howard, K., Lancsar, E., Huynh, E. K., Howell, M., Petrou, S., & Smith, S. C. (2024) · Value in Health · doi:10.1016/j.jval.2024.08.005 · Cited by 11
Long‐term value of lecanemab to individuals and families
Tysinger, B., Wei, Y., Heun‐Johnson, H., & Zissimopoulos, J. (2025) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.70151 · Cited by 9
Ross, A. B., Jacobs, A., Williams, K. L., Bour, R. K., & Gyftopoulos, S. (2021) · American Journal of Roentgenology · doi:10.2214/ajr.21.26419 · Cited by 9
Tam, A. C. T., Naik, H., Trenaman, L., Lynd, L. D., & Zhang, W. (2024) · The Journal of Headache and Pain · doi:10.1186/s10194-024-01882-4 · Cited by 9
“In addition to providing a single, overall assessment of a patients’ HRQoL [23], health utilities enable consistent comparisons of different interventions in terms of their improvement in health [24].”
BackgroundOptimal management of colorectal liver metastases in older patients: a decision analysis
Yang, S., Alibhai, S. M. H., Kennedy, E. D., El‐Sedfy, A., Dixon, M. E. B., Coburn, N. G., Kiss, A., & Law, C. (2014) · HPB · doi:10.1111/hpb.12292 · Cited by 9
The Utility Assessment Method Order Influences Measurement of Parents' Risk Attitude
Finnell, S. M. E., Carroll, A. E., & Downs, S. M. (2012) · Value in Health · doi:10.1016/j.jval.2012.04.008 · Cited by 9
Quality of Life and Outcomes in Glioblastoma Management
Colen, C. B., & Allcut, E. A. (2012) · Neurosurgery Clinics of North America · doi:10.1016/j.nec.2012.04.010 · Cited by 9
Interpretation of Health and Vision Utilities in Low Vision Patients
Malkin, A. G., Goldstein, J. E., & Massof, R. W. (2012) · Optometry and Vision Science · doi:10.1097/opx.0b013e318241720f · Cited by 9
“Some methods of estimating utilities allow for negative utility values to be extrapolated from the responses (presumably representing states worse than death).(20) The method FIGURE 1.”
MethodVickers, D., Canas, A., Degun, A., Briggs, J., Bingham, M., Toner, J. G., Cooper, H. R., Rogers, S., Cooper, S., Irving, R. M., et al. (2018) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2018.03.007 · Cited by 9
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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