Health and Well-Being

Lead Research Organisation: MRC Health Services Resrch Collaboration


Given the scarcity of resources in the NHS, it is important to examine the value for money (or cost effectiveness) of health services. This involves examining whether a treatment works, what the benefits are to patient s and what are the costs. This programme of work is concerned with the middle of these, which how do we assess the benefit to patients. A key measure of patient benefit used in assessing cost effectiveness has been the Quality Adjusted Life Year (QALY), which values health related quality of life on a scale from zero to one, where zero is for states regarded as bad as being dead and one for states that are in full health. ||The key problem has been how to come up with this value from zero to one. The dominant method for doing this in recent years has been to use a measure called a generic preference-based measure (such as the EQ-5D). However, there are many concerns existing methods, including how we describe health and well-being, how we derive the value and who should do the valuing. This programme is concerned with addressing these questions by undertaking an number of interconnected studies looking at different ways to describe health, different valuation methods and comparing the values of different people. It is also examining the way health impacts on peoples overall well-being or quality of life and trying understanding the role of mechanisms like coping. ||This programme should help to improve the methods used to value benefits and so provide better information to people deciding what services to provide in the NHS with its scarce resources.||

Technical Summary

The aim of this programme is to develop methods in the measurement and valuation of the benefits of health care. Its specific objectives are to address the key concerns of measuring QALYs, including: what is being valued (e.g. health or well-being); how is it to be described (e.g. which generic and generic vs. a measure specific to the treatment, condition or programme); how to value it (e.g. SG vs. TTO and the role of ordinal methods such as ranking and DCE); and whose values (e.g. patients or the general public).||Programme of work ||1) Develop methods in the construction and valuation of preference-based measures. ||2) Designing of measures in Children (Katherine Stevens -MRC Fellow), mental health (Caroline Lee-Abrahams - MRC HSRC Studentship), and a range of specific conditions (including Asthma, Overactive Bladder and sexual health) ||3) Examining the potential of ordinal methods to value health states. Specific work has included the valuation of generic and condition specific measures using rank and DCE data. Recently the PI has obtained an ward from the MRC Methodology and Implementation Programme to use ordinal methods of preference elicitation to map between measures in order to facilitate evidence synthesis ||4) Modelling health state data. Collaboration with Professor O Hagan and Dr. Kharroubi to develop a Bayesian method to model preference data. ||5) Examine the relationship between health and well-being. An analysis of a large cross sectional data set containing measures of health (EQ-5D/SF-36) and wellbeing. Survey of the general population using measures of health and well-being. MRC Studentship undertaking a mixed methods study of patients on waiting lists for knee replacement and Cataract operations to examine the role of coping and other psychological mechanisms in explaining the variation in the impact of health on well-being ||6) Mental health Review the use of generic measures in mental health. PhD student currently looking at developing a preference-based measure from the CORE Develop a preference-based mental health measure - currently at a proposal stage||This programme started in November 2004 with the funding of the PI and 2 studentships, otherwise it relies on grants from a range of bodies including the MRC, NHS HTA and pharmaceutical companies.||


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Ara R (2008) Deriving an algorithm to convert the eight mean SF-36 dimension scores into a mean EQ-5D preference-based score from published studies (where patient level data are not available). in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

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Bansback N (2007) Determinants of health related quality of life and health state utility in patients with age related macular degeneration: the association of contrast sensitivity and visual acuity. in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation

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Brazier J (2008) Estimation of a preference-based index from a condition-specific measure: the King's Health Questionnaire. in Medical decision making : an international journal of the Society for Medical Decision Making

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Brazier J (2008) Measuring and valuing mental health for use in economic evaluation. in Journal of health services research & policy

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Brazier JE (2010) A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures. in The European journal of health economics : HEPAC : health economics in prevention and care

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Brazier JE (2009) Estimating a preference-based index from the Japanese SF-36. in Journal of clinical epidemiology

Description NICE review of guidance
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact The NICE Guidance was revised
Description Epilepsy Research UK Project Grant (Health econmic evaluation in epilepsy:developing a preference-based outcome measure)
Amount £67,305 (GBP)
Funding ID P0903 
Organisation Epilepsy Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2009 
End 04/2011
Description Generation of preference-based measures from the DEMQoL and DEMQoL proxy for use in economic evaluation
Amount £550,000 (GBP)
Funding ID HTA/07/73/01 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 01/2009 
End 02/2011
Description MRC Research Grant (Development and testing of methods for deriving preference-based measures from condition specific measures)
Amount £167,286 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 10/2008 
End 09/2010
Description MRC Research Grant (Preparatory study for the Re-evaluation of the EQ-5D tariff (PRET))
Amount £249,000 (GBP)
Funding ID G0901500 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 09/2010 
End 03/2011
Description MRC Research Grant (Use of generic and condition specific measures in NICE decision-making)
Amount £280,727 (GBP)
Funding ID G0901486 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 04/2010 
End 03/2012
Description MRC Research Grant (Validating generic preference-based measures of health in mental health populations and estimating mapping functions for widely used specific measures)
Amount £222,313 (GBP)
Funding ID G0801394 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 07/2009 
End 02/2011
Title Preference-based weights 
Description Algorithms are now available for deriving a preference-based single index from measures of health including asthma, OAB and incontinence, 
Type Of Material Data analysis technique 
Year Produced 2008 
Provided To Others? Yes  
Impact Being used to generate values for econmic models 
Description DEMQoL utlities project 
Organisation King's College London
Department Institute of Psychiatry, Psychology & Neuroscience
Country United Kingdom 
Sector Academic/University 
PI Contribution I have been co-PI on a successful proposal
Collaborator Contribution Enabled us to apply our methods to an interesting new measure and to compare patienjt and general population values
Impact A grant from NIHR
Start Year 2008
Description MRC PRO meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Primary Audience Public/other audiences
Results and Impact Presenation of research issues

An MRC call
Year(s) Of Engagement Activity 2009
Description NICE 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Primary Audience Policymakers/politicians
Results and Impact Prepared the key paper to be considered at a workshop and reviewed drafts of revised guidance on econmic evaluation for NICE

The NICE guidance was revised
Year(s) Of Engagement Activity 2008