Constructing a utility algorithm for the pressure ulcer quality of life-utility instrument (PUQOL-UI)

Aim: Pressure Ulcers are an important health care problem, recognized as ‘Never Events’ by the US Government. To date, there is no instrument to capture their health utility impact, or the value of treatments and prevention strategies. The Pressure Ulcer Quality of Life Utility Instrument (PUQol-UI) is a condition specific preference-based measure designed to capture the impact of having a pressure ulcer (PU) on an individual’s health related quality of life and will allow calculation of QALYs necessary for cost-effectiveness analyses. PUQol-UI consists of 7 domains (Pain, Mobility, Activities of Daily Living, Energy, Depression, Burden and Social Function). Each domain has three possible response levels: ‘No Bother’, ‘Little Bother’, and ‘A lot of Bother’. Methods: A valuation exercise obtained Time Trade-Off values for 51 PUQol-UI health states in 200 interviews with the UK General Population. OLS, Random Effects and Fixed Effects linear regression models were fitted and evaluated using tests of standard goodness of fit and estimation and validation sample predictive performance. Results: The Random Effects model was superior in fit and predictive performance, with 83% of states predicted to within 0.1 of the observed mean. Preliminary analysis of the psychometric properties of the PUQoL-UI indicates adequate levels of validity and may offer measurement advantages over the generic EQ-5D measure. Conclusions: The PUQol-UI is a useful addition to the portfolio of condition specific utility measures available to researchers interested in economic evaluation of technologies for the management of pressure ulcers, and health care decision makers responsible for funding such technologies.