Using the Analytic Hierarchy Process to Derive Health State Utilities from Ordinal Preference Data

Background The EuroQol five-dimensional questionnaire is a standardized instrument used in the economic evaluation of health care to measure health state preferences across disease groups. A time trade-off (TTO) approach is commonly used to elicit preferences from the public. However, there are issues regarding how best to measure worse-than-dead states; at present, extreme valuations are rounded up to more acceptable values. TTO elicitation is also cognitively demanding for respondents and is therefore expensive to investigate. Objectives To describe how the analytic hierarchy process approach could be used to generate utilities from the ordinal relationships between the health states instead of the ordinal relationships between health states, allowing potentially useful preference data to be incorporated rather than excluded as they are at present. It was applied to the Measurement and Valuation of Health study data set, measuring health state preferences for the United Kingdom. Methods The analytic hierarchy process approach was explained. Five approaches to structure pairwise comparisons of health state preference were described (two concave, two convex, and one linear). Results All approaches described predicted the rankings of health states well. However, utilities derived followed an unconventional, bunched shape compared with the original Measurement and Valuation of Health TTO study. An approach was identified by optimizing the parameters, minimizing the sum of squared errors between the ordinal "health state ranking" approach and the original TTO-derived utilities. Conclusions This approach outlined offers the potential to convert ordinal preference data into cardinal utilities. It is simpler than TTO studies to carry out and removes the need to directly alter results of the preference ranking exercise.