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The Short-Form 36 (SF-36) Health Survey and Its Use in Pharmacoeconomic Evaluation

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Summary

The Short-Form 36 (SF-36) Health Survey is a brief self-administered questionnaire that generates scores across 8 dimensions of health. It has been found to be reliable, and valid in terms of criteria such as agreement with clinical diagnosis and disease severity, but its underlying values have not been tested against patient preferences.

The SF-36 was not devised for use in economic evaluation. The SF-36 may be used in cost-minimisation analyses. where the dimension scores can be shown to reflect people’s values for health at an ordinal level, but it cannot be used in either cost-effectiveness or cost-utility analyses. The dimension scores of zero to 100 do not provide a common currency and, where there is conflict between the dimension scores, there is no basis for establishing an overall health benefit. Furthermore, in clinical trials, the usual comparison is between mean or median scores, which assumes risk neutrality and docs not take adequate account of the relationship between the value of health and time.

Although they are under pressure to assess the cost effectiveness of health care interventions, researchers and policy analysts must resist short-cut methods of deriving a single index, from the SF-36 that are based on arbitrary aggregation schemes, because these ignore people’s preferences and the crucial quantity/ quality trade-off, and therefore cannot be used in economic evaluations. However, the rich descriptive material and multidimensionality of the SF-36 may have potential for use in economic evaluation. Multi-attribute utility theory provides a way of deriving a single index based on elicited values, but it requires a major restructuring of the scales of the SF-36. Alternatively, SF-36 rcsponses may provide material for constructing health scenarios that could then be valued on a holistic basis.

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References

  1. Drummond MF. Cost–effectiveness guidelines for reimbursement of pharmaceuticals: is economic evaluation ready for its enhanced status? Health Econ 1992: 1: 85–92

    Article  PubMed  CAS  Google Scholar 

  2. Ellwood PM. Outcomes management: a technology of patient experience. N Engl J Med 1988; 318: 1549–56

    Article  PubMed  CAS  Google Scholar 

  3. Ware JE, Sherbourne CD. The MOS 36–item Short–Form Health Survey (SF–36): I. Conceptual framework and item selection. Med Care 1992; 30: 473–83

    Article  PubMed  Google Scholar 

  4. Aaronson NK, Acquadro C, Alonso J, et al. International quality of life assessment (QOLA) project. Qual Life Res 1992; 1: 349–51

    Article  PubMed  CAS  Google Scholar 

  5. Torrance GW. Social preferences for health states: an empirical evaluation of three measurement techniques. Socioecon Plan Sci 1976; 10 (3): 128–36

    Google Scholar 

  6. Torrance GW. Multi–attribute utility theory as a method of measuring social preferences for health states in long–term care. In: Kane RL, Kane RA, editors. Values in long term care. Lexington: Lexington Books DC Health and Company, 1982

    Google Scholar 

  7. Kaplan RM, Anderson JP. The general health policy model: an integrated approach. Quality of life assessments in clinical trials. New York: Raven Press Ltd. 1990

    Google Scholar 

  8. Kaplan RM, Bush JW, Berry C. Health status: types of validity and the index of welI–being. Health Serv Res 1976 Winter; 11 (4): 478–507

    PubMed  CAS  Google Scholar 

  9. Kaplan RM, Bush JW. Health–related quality of life measurement for evaluation of research and policy analysis. Health Psychol 1982; 1 (1): 61–80

    Article  Google Scholar 

  10. The Euroqol group. Euroqol: a new facility for the measurement of health related quality of life. Health Policy 1990; 16 (3): 199–208

    Article  PubMed  Google Scholar 

  11. Medical Outcomes Trust. How to score the SF–36 Health Survey. Boston: Medical Outcome Survey, 1993

  12. Brook RH, Ware JE, Roberts WR, et al. Does free care improve adults’ health? Results from a randomised controlled trial. N Engl J Med 1983; 309: 1426–34

    Article  PubMed  CAS  Google Scholar 

  13. Brook RH, Ware JE, Davies–Avery A, et al. Overview of adult health status measures fielded in Rand’s Health lnsurance Study. Med Care 1979; 17 Suppl.: 7

    Google Scholar 

  14. Tarlov AR, Ware JE, Greenfield S, et al. The medical outcomes study: an application of methods for monitoring the results of medical care. JAMA 1983; 262: 925–30

    Article  Google Scholar 

  15. Ware JE, Snow KK, Kosinski M, et al. SF–36 Health Survey manual and interpretation guide. Boston: The Health Institute,New England Medical Center, 1993

    Google Scholar 

  16. Nunnally JC. Psychometric theory. New York: McGraw–Hill Book Co., 1967

  17. McDowell I, Newell C. Measuring health. A guide to rating scales and questionnaire. Oxford: Oxford University Press, 1987

    Google Scholar 

  18. Stewart AL, Ware J, editors. Measuring functioning and wellbeing. Durham, NC: Duke University Press, 1992

  19. McHorney CA, Ware JE, Lu JFR, et al. The: MOS 36–item Short Form Health Survey (SF–36): III. Test of data quality, assumptions and reliabilily across diverse patient groups. Med Care: 1994; 32: 40–52

    Article  PubMed  CAS  Google Scholar 

  20. Stewart AL, Hays RD, Ware JE. The MOS short–form General Health Survey: reliability and validity in a patient population. Med Care 1988; 26 (7): 724–35

    Article  PubMed  CAS  Google Scholar 

  21. Brazier JE, Harper R, Jones NMB, et al. Validating the SF–36 health survey questionnaire: new outcome measure for primary care. WHO: Constitution of the World Health Organisation, Documents. Geneva: WHO, 1948. BMJ 1992; 305; 160–4

    Article  PubMed  CAS  Google Scholar 

  22. Ware JE. Standards for validating health measures: definition and content. J Chronic Dis 1987; 40 (6): 473–80

    Article  PubMed  Google Scholar 

  23. Hunt SM, McEwen J, McKenna SP. Measuring health Status. London: Croom Helm, 1986

    Google Scholar 

  24. Carter W, Bobbitt R, Bergner M, et al. Validation of an interval scaling: the sickness impact profile. Health Serv Res 1976; 11: 516–28

    PubMed  CAS  Google Scholar 

  25. Mchorney CA, Ware JE, Raczek AK. The MOS 36–item Short Form Health Survey (SF–36): II. Psychometric and clinical test of validity in measuring physical and mental heallh constructs. Med Care 1993: 31: 247–63

    Article  PubMed  CAS  Google Scholar 

  26. Garrat AM, Ruta DA, Abdalla MI, et al. The SF–36 health survey questionnaire: an outcome measure suitable for routine use within the NHS. BMJ 1993; 306: 1440–4

    Article  Google Scholar 

  27. Vickrey BG, Mays RD, Graber J, et al. A health–related quality of life instrument for patients evaluated for epilepsy surgery. Med Care 1992; 30: 299–319

    Article  PubMed  CAS  Google Scholar 

  28. Nerenz DR, Repasky YP, Whitehouse MD, et al. Ongoing assessment of health status in patients with diabetes mellitus using the SF–36 and diabetes TYPE scale. Med Care 1992; 30 (5): MS240–52

    Google Scholar 

  29. Kurtin PS, Davies AR, Meyer KB, et al. Patient–based health status measurements in outpatient dialysis: early experiences in developing an outcomes assessment program. Med Care 1992; 30 (5): MS136–49

    Article  PubMed  CAS  Google Scholar 

  30. Berwick OM, Murphy JA, Goldman PA, et al. Performance of a five item mental health screening test. Med Care 1991; 29 (2): 169–76

    Article  PubMed  CAS  Google Scholar 

  31. Katz JN, Larson MG, Phillips CB, et ul. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30: 917–25

    Article  PubMed  CAS  Google Scholar 

  32. Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF–36 health survey questionnaire. Qual life Res 1993: 2: 169–80

    Article  PubMed  CAS  Google Scholar 

  33. Williams A. Measuring functioning and well–being, by Stewart and Ware. Health Econ 1992; 1 4): 255–8

    Article  Google Scholar 

  34. Deyo RA, Lnui TS. Toward clinical applications of health Status measures: sensitivity of scales to clinically important changes [editorial]. Health Serv Res 1984: 19 (3): 275

    PubMed  CAS  Google Scholar 

  35. Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987

  36. Cairns J, Johnston K, McKenzie L. Developing QALYs from condition specific outcome measures. HERU DP 14/91. Aberdeen: University of Aberdeen, 1991

    Google Scholar 

  37. Loomes G, McKenzie L. The use of QALYs in health care decision making. Soc Sci Med 1989: 28 (4): 299–308

    Article  PubMed  CAS  Google Scholar 

  38. Gafni A, Birch S, Mehrez A, Economics, health and health economics: HYEs vs. QALYs. J Health Econ 1993; 12 (3): 325–40

    Article  PubMed  CAS  Google Scholar 

  39. Culyer AJ, Wagstaff A, QALYs vs. HYEs. J Health Econ 1993; 12 (3): 311–24

    Article  PubMed  CAS  Google Scholar 

  40. Nicholl J, Brazier JE, Milner PC, et al. Randomised controlled trial of cost–ffectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones. Lancet 1992: 340: 801–7

    Article  PubMed  CAS  Google Scholar 

  41. Gudex C. QALYs and their use by the Health Service [Discussion Paper 20]. York: Centre for Health Economics, University of York, 1986

    Google Scholar 

  42. Sackett DL, Torrance GW, The utility of different health states as perceived by the general public. J Chronic Dis 1978: 31 (11); 697–709

    Article  PubMed  CAS  Google Scholar 

  43. Richardson J, Hall J, Salkeld G. CUA: the compatibility of measurement techniques and the measurement of ulility through time. In: Selby-Smith C, editor. Economics and Health Clayton, VIC: Monash University, 1989: 31–52

    Google Scholar 

  44. Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986; 5; 1–19

    Article  PubMed  CAS  Google Scholar 

  45. Revicki DA, Kaplan RM, Relationship between psychometric and utility–based approaches to the measurement of health related quality of life. Qual Life Res 1993: 2 (3): 477–87

    Article  PubMed  CAS  Google Scholar 

  46. Revicki DA, Relationship between health utility and psychometric health status measures. Med Care 1992; 30 (Suppl.): MS274–82

    Article  Google Scholar 

  47. Katz JN, Phillips CB, Fossel AH, et al. Stability and responsivenes of utility measures. Med Care 1994; 32 (2): 183–8

    Article  PubMed  CAS  Google Scholar 

  48. Laupacis A. The Canadian Erythropoietin Study Group. BMJ 1990; 300: 573–8

    Article  Google Scholar 

  49. O’Brien BJ, Buxton MJ, Ferguson BA. Measuring the effetiveness of heart transplant programmes: quality of life data and their relationship to survival analysis. J Chronic Dis 1987; 40 (1): 1375–85

    Google Scholar 

  50. McKenna S, Hunt SM, Tennant A. The development of a patient–completed index of distress from the Nottingham Health Profile: a new measure for use in cost–utility studies, Br J Med Econ 1993; 6: 13–24

    Google Scholar 

  51. Feeny D, Furlong W, Barr RD, et al. A comprehensive multi–attribute system for classifying the health status of survivors of childhood cancer. J Clin Oncol 1992; 10 (6); 923–8

    PubMed  CAS  Google Scholar 

  52. Keeney RL, Raiffa H, Decisions with multiple objectives: preferences and value tradeoffs, New York: John Wiley and Sons, 1976

    Google Scholar 

  53. Brazier JE. The SF–36 Health Survey Questionnaire–a tool for economics. Health Econ 1993: 2: 213–5

    Article  PubMed  CAS  Google Scholar 

  54. Brazier JE, Usherwood T, Harper R, et al. Deriving a single index for health from the SF–36: interim report for the Department of Health, Sheffield: University of Sheffield, 1994

    Google Scholar 

  55. Hall J, Gerard K, Salkeld G, et al. A cost utility analysis of mammography screening in Australia. Soc Sci Med 1992; 34 (9): 993–1004

    Article  PubMed  CAS  Google Scholar 

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Brazier, J. The Short-Form 36 (SF-36) Health Survey and Its Use in Pharmacoeconomic Evaluation. Pharmacoeconomics 7, 403–415 (1995). https://doi.org/10.2165/00019053-199507050-00005

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