Association between preference-based health-related quality of life and asthma severity

Marilyn L. Moy, Anne L. Fuhlbrigge, Karen Blumenschein, Richard H. Chapman, Alan J. Zillich, Karen M. Kuntz, A. David Paltiel, Barrett T. Kitch, Scott T. Weiss, Peter J. Neumann

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background: Preference-based measures of health-related quality of life (HRQL) focus on choice and strength of preference for health outcomes. If the value people attach to the health improvement they receive from medical treatments for asthma is known, preference-based measures can be used in cost-effectiveness analyses to aid resource allocation decisions. International guidelines have been developed to guide medical management according to asthma severity defined by lung function and symptom frequency. Objective: To test the hypothesis that preferences correlate with asthma severity and that the relationships vary among the preference instruments used and the components of asthma severity studied. Methods: Preferences for subjects' health states were measured using (1) a rating scale (RS), (2) standard gamble (SG), (3) time tradeoff (TTO), (4) Health Utilities Index 3 (HUI3), and (5) Asthma Symptom Utility Index (ASUI). We measured level of airways obstruction by forced expiratory volume in 1 second (FEV1) and symptom frequency of cough, wheeze, dyspnea, and nighttime awakening. Asthma severity was defined by either percentage of predicted FEV1 or symptom frequency. Results: One hundred adults with asthma were studied. Preference scores were lowest for the HUI3 (mean, 0.57) and highest for the SG (mean, 0.91). Spearman correlations showed that the strength of the relationship between preference scores and percentage of predicted FEV1 was weak to moderate (r = 0.14-0.36). One-way analysis of variance showed that RS, TTO, and ASUI scores were significantly associated with the percentage of predicted FEV1 (P ≤ .01). Both RS and HUI3 scores were significantly associated with frequency of all symptoms (P < .05). Conclusions: Preference-based measures of HRQL are correlated with asthma severity defined by lung function or symptoms. The RS was significantly associated with level of airways obstruction and all 4 symptoms evaluated, whereas the SG was not correlated with either marker of asthma severity.

Original languageEnglish
Pages (from-to)329-334
Number of pages6
JournalAnnals of Allergy, Asthma and Immunology
Issue number3
StatePublished - Mar 2004

Bibliographical note

Funding Information:
* Division of Pulmonary and Critical Care Medicine and Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. † University of Kentucky College of Pharmacy and Martin School of Public Policy and Administration, Lexington, Kentucky. ‡ Program on the Economic Evaluation of Medical Technology, Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts. § University of Iowa College of Pharmacy, Iowa City, Iowa. ¶ Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut. This study was funded in part by the American Association of Colleges of Pharmacy New Investigator Award (Dr. Blumenschein), Astra Zeneca Inc, and the National Heart, Lung, and Blood Institute (R01-HL68201–01A1 to Dr. Paltiel and K08-HL03910–01 to Dr. Fuhlbrigge). Received for publication February 26, 2003. Accepted for publication in revised form September 18, 2003.

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine


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