Comparing the Health Utilities Index Mark 3 (HUI3) with the Short Form-36 Preference-Based SF-6D in Chronic Kidney Disease

Objective:  Assess within-subject agreement and compare discriminative abilities between the SF-6D and the Health Utilities Index Mark 3 (HUI3) in patients with chronic kidney disease (CKD).
Methods:  The HUI3 and Short Form-36 were self-completed by 185 CKD patients enrolled in a prospective study of incident patients with stage 4 and 5 CKD.
Results:  The mean preference-based score for the SF-6D was 0.67 ± 0.13 compared to 0.58 ± 0.26 for the HUI3 ( P  < 0.01). There was a strong association between SF-6D and HUI3 scores (Pearson correlation coefficient 0.55, 95% CI 0.43–0.65) and moderate agreement with an intraclass correlation coefficient of 0.44. The HUI3 was better able to capture more severe burden of illness with fewer floor effects. The SF-6D was better at capturing differences among patients at the top range of the scale with fewer ceiling effects. Both the HUI3 and SF-6D were able to discriminate between patient groups differing in disease severity defined as predialysis versus dialysis dependent and depressive symptoms using a Beck Depression Inventory II score of ≥14 as the cutoff. The HUI3 was better able to discriminate greater depressive symptoms.
Conclusion:  The SF-6D and the HUI3 generate different preference-based scores for patients with CKD and any comparison between their scores should be made with caution. The HUI3 appears more suitable for measuring the health of populations with greater disability such as patients with CKD. It remains to be determined whether these differences will remain when one compares within-instrument differences in preference scores over time.     

Not all "quality-adjusted life years" are equal

BACKGROUND: There is evidence that utility elicitation methods used in the calculation of quality-adjusted life years (QALYs) yield different results. It is not clear how these differences impact economic evaluations. METHODS: Using a mathematical model incorporating data on efficacy, costs, and utility values, we simulated the experiences of 100,000 hypothetical rheumatoid arthritis patients over 10 years (50,000 exposed to infliximab plus methotrexate [MTX] and 50,000 exposed to MTX alone). QALYs, were derived from the Health Utilities Index 2 and 3 (HUI2 and HUI3), the Short Form 6-D (SF-6D), and the Euroqol 5-D (EQ-5D). Incremental cost-utility ratios were determined using each instrument to calculate QALYs and the results were compared using cost-effectiveness acceptability curves. RESULTS: Using the different utility measurement methods, the mean difference in QALYs between the infliximab plus MTX and MTX groups ranged from a high of 1.95 QALYs (95% CI=1.93-1.97) using the HUI3 to 0.89 QALYs (95% CI=0.88-0.91) using the SF-6D. Adopting the commonly cited value of society's willingness to pay for a QALY of $50,000, 91% of the simulations favored the cost utility of infliximab plus MTX when using the HUI3 to calculate QALYs. However, when using the EQ-5D, HUI2, or the SF-6D utility values to calculate QALYS, the proportion of simulations that favored the cost utility of infliximab were 63%, 45%, and 12%, respectively. CONCLUSION: Depending on the method for determining utility values used in the calculation of QALYs, very different incremental cost-utility ratios are generated.     

Comparing Short Form 6D,Standard Gamble,and Health Utilities Index Mark 2 and Mark 3 utility scores: Results from total hip arthroplasty patients

Objective: The objectives are to compare SF-6D, standard gamble (SG), and Health Utilities Index (HUI) utility scores, compare change scores, and compare responsiveness. Methods: A cohort of osteoarthritis patients referred for total hip arthroplasty (THA) were evaluated at the time of referral and followed until 3months after THA. Patients were assessed using the SF-36, HUI2, HUI3, and the SG. Agreement is assessed using the intra-class correlation (ICC). Responsiveness is assessed using effect size, standardized response mean, and paired t-test. Results: Data was available for 86 patients at baseline and for 63 at both pre- and post-surgery. At baseline mean SF-6D (0.61), SG (0.62), and HUI2 (0.62) scores were similar; the mean HUI3 score (0.52) was lower. Standard deviations were 0.10, 0.32, 0.19, and 0.22. At baseline, agreement between SF-6D and SG scores was 0.13, agreement between SF-6D and HUI2 was 0.47, and agreement between SF-6D and HUI3 was 0.28. Agreement at pre- and post-surgery was similar. The change in scores between post- and pre-surgery was 0.10 for SF-6D, 0.16 for SG, 0.22 for HUI2, and 0.23 for HUI3. Effect sizes were 1.10 for HUI2, 1.08 for HUI3, 1.06 for SF-6D, and 0.48 for the SG. Conclusions: Agreement between SG scores and SF-6D and HUI scores was low. The estimate of change in utility associated with THA was lowest for SF-6D. Additional longitudinal studies to compare utility measures appear to be warranted.     

Comparing utility scores before and after hearing-aid provision

Utility scores were estimated for 609 hearing-impaired adults who completed EQ-5D, Health Utilities Index Mark III (HUI3) and SF-6D survey instruments both before and after being provided with a hearing aid. Pre-intervention, the mean utility scores for EQ-5D (0.80) and SF-6D (0.78) were significantly higher than the mean HUI3 utility score (0.58). Post-intervention, the mean improvement in the HUI3 (0.06 change) was significantly higher than the mean improvement according to the EQ-5D (0.01 change) or SF-6D (0.01 change). The estimated cost effectiveness of hearing-aid provision is therefore likely to be dependent on which instrument is used to measure utility.     

Evaluating quality-adjusted life years: estimation of the health utility index (HUI2) from the SF-36.

Quality-adjusted life years (QALYs) are well recognized as a valid measure for outcomes in cost-effectiveness analyses. A summary health utility score is necessary to evaluate QALYs. The objective of this study was to predict a summary utility score (represented by the Health Utility Index [HUI2]) from scores on the SF-36. METHODS: A structural equation framework was applied to longitudinal data collected from 1992 to 1995 on a sample of patients insured by Southem California Kaiser Permanente (N = 6921). An ordinary least squares (OLS) method was used to estimate the HUI2. RESULTS: The OLS model on cross-sectional data predicted 50.5% of the observed variance in HUI2 scores. Parameter estimates of all SF-36 components showed statistical significance at the P < 0.05 level. CONCLUSIONS: Results of this study provide a quantitative link between two important measures of health status. The present model can be used to estimate health utility summary scores in studies that have collected SF-36 data.     

Comparison of preference-based utilities of the Short-Form 36 Health Survey and Health Utilities Index before and after treatment of patients with intermittent claudication.

The authors compared SF-36 utilities with Health Utilities Index (HUI) utilities (HUI2 and HUI3) assessed in patients with intermittent claudication. A total of 87 patients with intermittent claudication completed the SF-36 and HUI before and 1, 3, and 12 months after revascularization. Utilities were estimated using SF-36 and HUI published algorithms (i.e., both algorithms were based on standard-gamble utilities assessed in random samples of the general population). The utilities were compared using repeated-measures multivariate analysis of variance, paired t tests, and univariate linear regression analyses. Before treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.66, P = 0.92) and less than the mean HUI2 utility (0.70, P = 0.02). After treatment, all utilities showed improvement from before treatment (P < 0.05); the gain in utilities from treatment was lowest when using the SF-36 (e.g., 0.74, 0.80, 0.77 at 3 months for the SF-36, HUI2, and HUI3, respectively). The correlations of changes over time of the SF-36 with HUI2 utilities and of the SF-36 with HUI3 utilities were 0.39 and 0.49, respectively. The relationships between the SF-36 and HUI2 or HUI3 utilities were moderate to good (i.e., range-adjusted R2 = 31% to 72%). The results suggest that SF-36 data can be transformed to preference-based utilities and be used for economic evaluation in health care. The gain in utilities from treatment, however, was less for SF-36 utilities than for HUI utilities.     

Assessing Differences in Utility Scores: A Comparison of Four Widely Used Preference-Based Instruments

OBJECTIVES: To characterize the differences in utility scores (dUTY) among four commonly used preference-based Health-Related Quality of Life instruments, to evaluate the potential impact of these differences on cost-utility analyses (CUA), and to determine if sociodemographic/clinical factors influenced the magnitude of these differences. METHODS: Consenting adult Chinese, Malay and Indian subjects in Singapore were interviewed using Singapore English, Chinese, Malay or Tamil versions of the EQ-5D, Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), and SF-6D. Agreement between instruments was assessed using Bland-Altman (BA) plots. Changes in incremental cost-utility ratio (ICUR) from dUTY were investigated using eight hypothetical decision trees. The influence of sociodemographic/clinical factors on dUTY between instrument pairs was studied using multiple linear regression (MLR) models for English-speaking subjects (circumventing structural zero issues). RESULTS: In 667 subjects (median age 48 years, 59% female), median utility scores ranged from 0.80 (95% confidence interval [CI] 0.80, 0.85) for the EQ-5D to 0.89 (95% CI 0.88, 0.89) for the SF-6D. BA plots: Mean differences (95% CI) exceeded the clinically important difference (CID) of 0.04 for four of six pairwise comparisons, with the exception of the HUI2/EQ-5D (0.03, CI: 0.02, 0.04) and SF-6D/HUI2 (0.02, CI: 0.006, 0.02). Decision trees: The ICER ranged from $94,661/QALY (quality-adjusted life-year; 6.3% difference from base case) to 100,693 dollars/QALY (0.3% difference from base case). MLR: Chronic medical conditions, marital status, and Family Functioning Measures scores significantly (P-value < 0.05) influenced dUTY for several instrument pairs. CONCLUSION: Although CIDs in utility measurements were present for different preference-based instruments, the impact of these differences on CUA appeared relatively minor. Chronic medical conditions, marital status, and family functioning influenced the magnitude of these differences.     

Are indirect utility measures reliable and responsive in rheumatoid arthritis patients?

Background: Preference-based, generic measures are increasingly being used to measure quality of life and as sources for quality weights in the estimation of Quality Adjusted Life Years (QALYs) in rheumatoid arthritis (RA). However, among the most commonly used instruments (the Health Utilities Index 2 and 3 [HUI2 and HUI3], the EuroQoL-5D [EQ-5D], and the Short Form-6D [SF-6D], there has been little comparative research. Therefore, we examined the reliability and responsiveness of these measures and the Rheumatoid Arthritis Quality of Life (RAQoL) and the Health Assessment Questionnaire (HAQ) in a sample of RA patients. Major findings: Test–retest reliability was acceptable for all of the instruments with the exception of the EQ-5D. Using two external criteria to define change (a patient transition question and categories of the patient global assessment of disease activity VAS), the RAQoL was the most responsive of the instruments. For the indirect utility instruments, the HUI3 and the SF-6D were the most responsive for measuring positive change. On average, for patients whose RA improved, the absolute change was highest for the HUI3. Conclusions: The HUI3 and the SF-6D appear to be the most responsive of the preference-based instruments in RA. However, differences in the magnitude of the absolute change scores have important implications for cost-effectiveness analyses.     

Exploring the validity of estimating EQ-5D and SF-6D utility values from the health assessment questionnaire in patients with inflammatory arthritis

Background  

Utility scores are used to estimate Quality Adjusted Life Years (QALYs), applied in determining the cost-effectiveness of health care interventions. In studies where no preference based measures are collected, indirect methods have been developed to estimate utilities from clinical instruments. The aim of this study was to evaluate a published method of estimating the EuroQol-5D (EQ-5D) and Short Form-6D (SF-6D) (preference based) utility scores from the Health Assessment Questionnaire (HAQ) in patients with inflammatory arthritis.     

An empirical comparison of EQ-5D and SF-6D in liver transplant patients

There remains disagreement about the preferred utility-based measure of health-related quality of life for use in constructing quality-adjusted life years (QALYs). The recent development of a new measure, the SF-6D, has highlighted this issue. The SF-6D and EuroQol EQ-5D measure health-related utilities on a scale where 0 represents death and 1 represents full health, and both have utility scores generated from random samples of the general UK population. This study explored whether, in a large sample of liver transplant patients, the two instruments provide similar results. The empirical data highlight important variation in the results generated from the use of the two instruments. The data are consistent with a view that the SF-6D does not describe health states at the lower end of the utility scale but is more sensitive than EQ-5D in detecting small changes towards the top of the scale.     

Patients undergoing knee surgery provided accurate ratings of preoperative quality of life and function 2 weeks after surgery

OBJECTIVE: To evaluate patients' ability to recall their preoperative self-reported quality of life, function, and general health 2 weeks postoperatively. STUDY DESIGN AND SETTING: We randomized consecutive patients undergoing arthroscopic knee surgery to group I (assessments at 4 weeks preoperatively, on the day of surgery, and 2 weeks and 12 months postoperatively) or group II (assessments at 2 weeks and 12 months postoperatively). At each visit patients completed disease-specific, knee-specific, and generic health rating scales. At a median of 2 weeks postoperative (range, 0.6 to 14 weeks), patients completed questionnaires according to their recollection of their health 2 weeks before surgery. RESULTS: Agreement between actual and recalled data was excellent for disease-specific (ICC(WOMET)=0.88 (95% CI 0.82-0.91), ICC(ACL-QOL)=0.86 (95% CI 0.75-0.91)), knee-specific (ICC(IKDC)=0.92 (95% CI 0.90-0.94), ICC(KOOS)=0.93 (95% CI 0.91 to 0.95), and general physical health (ICC(SF-36(PCS))=0.81 (95% CI 0.75-0.86)) instruments. Agreement for general mental health was moderate (ICC(SF-36(MCS))=0.67 (95% CI 0.58-0.75). Greater error associated with recalled ratings contributed to small increases in sample size requirements or small decreases in power to detect differences between groups. CONCLUSION: Patients recalled their preoperative quality of life, function, and general health at 2 weeks postoperative with sufficiently high accuracy to warrant substituting prospectively collected baseline data with recalled ratings.     

The feasibility and responsiveness of the health utilities index in patients with early-stage breast cancer: A prospective longitudinal study

Background The health utilities index (HUI3) is a health measurement instrument based on individuals’ preferences for different health states. Breast cancer (BC) is common, with a high proportion of long-term survivors, making evaluation of treatment effects important. Feasibility and responsiveness of HUI3 was compared to the short-form 36 (SF-36) in patients with BC. Methods HUI3 and SF-36 were administered eight times: at initial surgical consultation, 1 week before surgery; 1 week, 3, 6, 12, 18, and 24 months after surgery. Effect size, analysis of variance, and Pearson product moment correlations were calculated. BC data were compared to normative values. Results Eighty-five patients were enrolled. Ninety-one percent of planned assessments were completed. HUI3 showed significant responsiveness (P < 0.01) after surgery and during recovery. HUI3 scores correlated with SF-36 scores. Comparison to normative data demonstrated the significant detrimental effect of BC diagnosis. Results showed long-term effects of treatment on physical health and positive effects on mental/emotional health in BC survivors. Conclusion(s) HUI3 was found to be feasible and responsive in our cohort of BC patients. Changes in HUI3 values over time, and compared to normative data, paralleled SF-36 scores. HUI3 is a valuable tool in health-related quality of life and cost-utility studies in patients with BC.     

A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis

Rheumatoid arthritis (RA) is a common, chronic disease where health-related quality of life (HRQL) is one of the main goals of therapy. As such, instruments used to measure HRQL in RA must be able to discriminate across RA severity. The two basic categories of instruments used to measure HRQL are generic instruments and disease-specific instruments. Generic instruments can be further subdivided into preference-based measures which yield both single and multi-attribute utility values anchored at zero (death) and 1.00 (perfect health) as a measure of HRQL. The scores from these types of instruments can be integrated into cost-utility analyses as the weightings for quality adjusted life years. We assessed the construct validity of utility scores from four generic preference-based measures (the Health Utilities Index 2 and 3 (HUI2, HUI3), the EuroQol 5D (EQ-5D), and the Short Form 6-D (SF-6D) and disease specific measures (the Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) and the Health Assessment Questionnaire (HAQ)) in a sample of 313 RA patients in British Columbia, Canada. We also estimated the minimally important differences (MID) for each of the measures. Generally, as anticipated, the disease-specific measures were better able to discriminate across groups with higher RA severity; however, utility scores from each of the scales also appeared to discriminate well across RA severity categories. The MID values agreed with those previously reported in the literature for the HUI2, SF-6D and the HAQ and provided new information for the HUI3, EQ-5D and the RAQoL. We conclude that the all of the preference-based utility measures that were evaluated appear to adequately discriminate across levels of RA severity.     

MGA5 Health Utilities Index: Further Evidence of Responsiveness

Quality adjusted life years (QALYs) are well recognized as a valid measure for outcomes in cost-effectiveness analyses. However, it is difficult to obtain a summary utility score from health status measure such as the SF-36.
OBJECTIVE: To predict a summary utility score (represented by HUI) from the scores on the SF-36.
METHODS: A structural equation framework was applied to data collected from 1992 to 1995 on the Southern California Kaiser Permanente population (n = 5,794). An instrumental variable (IV) method mitigated the endogeneity in estimating the HUI(MarkII). Socioeconomic and disease variables were used as covariates. A split-sample analysis provided cross-validation.
RESULT: This model predicted 33.68% of the observed variance in HUI index scores with an adjusted R²of 0.3335. Observed HUI index scores were distributed with a mean of 0.7963 and std. deviation of 0.1796. Parameter estimates of most of the SF-36 components (except General Health & Social Functioning) showed statistical significance at α= 0.05 level. People with high chronic disease scores were found to have low SF-36 scores, and parameter estimates of this covariate were also found statistically significant at α= 0.05 level in all structural equations. However, all the socioeconomic variables showed statistical insignificance. Comparison of "Forecasting" and "Estimation" sub-samples showed satisfactory results during cross-validation.
CONCLUSION: Result of this study provides a quantitative link between two important measures of health status. The present model can be used to estimate overall health utility summary scores from previous studies using the SF-36.     

Discordance in Utility Measurement in Persons with Neurological Conditions: A Comparison of the SF-6D and the HUI3

Objectives

To examine the extent of disagreement in estimated utility between the six-dimensional health state short form (SF-6D) and the Health Utilities Index—Mark 3 (HUI3) in Canadians with neurological conditions and how discordance varied by participant and neurological condition attributes.

Utility scores for different health states related to depression: individual participant data analysis

Objectives

Depression is associated with considerable impairments in health-related quality-of-life. However, the relationship between different health states related to depression severity and utility scores is unclear. The aim of this study was to evaluate whether utility scores are different for various health states related to depression severity.

Methods

We gathered individual participant data from ten randomized controlled trials evaluating depression treatments. The UK EQ-5D and SF-6D tariffs were used to generate utility scores. We defined five health states that were proposed from American Psychiatric Association and National Institute for Clinical Excellence guidelines: remission, minor depression, mild depression, moderate depression, and severe depression. We performed multilevel linear regression analysis.

Results

We included 1629 participants in the analyses. The average EQ-5D utility scores for the five health states were 0.70 (95% CI 0.67–0.73) for remission, 0.62 (95% CI 0.58–0.65) for minor depression, 0.57 (95% CI 0.54–0.61) for mild depression, 0.52 (95%CI 0.49–0.56) for moderate depression, and 0.39 (95% CI 0.35–0.43) for severe depression. In comparison with the EQ-5D, the utility scores based on the SF-6D were similar for remission (EQ-5D?=?0.70 vs. SF-6D?=?0.69), but higher for severe depression (EQ-5D?=?0.39 vs. SF-6D?=?0.55).

Conclusions

We observed statistically significant differences in utility scores between depression health states. Individuals with less severe depressive symptoms had on average statistically significant higher utility scores than individuals suffering from more severe depressive symptomatology. In the present study, EQ-5D had a larger range of values as compared to SF-6D.

     

An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population

BACKGROUND: An important consideration for studies that derive utility scores using multi-attribute utility measures is the psychometric integrity of the measurement instrument. Of particular importance is the requirement to establish the empirical validity of multi-attribute utility measures; that is, whether they generate utility scores that, in practice, reflect people's preferences. We compared the empirical validity of EQ-5D versus SF-6D utility scores based on hypothetical preferences in a large, representative sample of the English population. METHODS: Adult participants in the 1996 Health Survey for England (n=16 443) formed the basis of the investigation. The subjects were asked to complete the EQ-5D and SF-36 measures. Their responses were converted into utility scores using the York A1 tariff set and the SF-6D utility algorithm, respectively. One-way analysis of variance was used to test the hypothetically constructed preference rule that each set of utility scores differs significantly by self-reported health status (categorised as very good, good, fair, bad or very bad). The degree to which EQ-5D and SF-6D utility scores reflect alternative configurations of self-reported health status; illness, disability or infirmity, and medication use was tested using the relative efficiency statistic and receiver operating characteristic (ROC) curves. RESULTS: The mean utility score for the EQ-5D was 0.845 (95% CI: 0.842, 0.849), whilst the mean utility score for the SF-6D was 0.799 (95% CI: 0.797, 0.802), representing a mean difference in utility score of 0.046 (95% CI: 0.044, 0.049; p<0.001). Bland-Altman plots displayed considerable lack of agreement between the two measures, particularly at the lower end of the utility scale. Both measures demonstrated statistically significant differences between subjects who described their health status as very good, good, fair, bad or very bad (p<0.001), as well as monotonically decreasing utility scores (test for linear trend: p<0.001). The SF-6D was between 30.9 and 100.4% more efficient than the EQ-5D at detecting differences in self-reported health status, and between 10.4 and 45.6% more efficient at detecting differences in illness, disability or infirmity and medication use. The area under the curve scores generated by the ROC curves were significantly higher for the SF-6D at the 0.1% significance level when self-reported health status was dichotomised as very good versus good, fair, bad or very bad. However, the AUC scores did not reveal any significant differences in the discriminatory powers of the measures when alternative configurations of illness, disability or infirmity and medication use were examined. CONCLUSIONS: This study provides evidence that the SF-6D is an empirically valid and efficient alternative multi-attribute utility measure to the EQ-5D, and is capable of discriminating between external indicators of health status. However, health economists should also consider other psychometric properties, such as practicality and reliability, when selecting either measure for evaluative purposes.     

The effect of weight loss on changes in health-related quality of life among overweight and obese women with urinary incontinence

Objective

To estimate the effect of change in weight and change in urinary incontinence (UI) frequency on changes in preference-based measures of health-related quality of life (HRQL) among overweight and obese women with UI participating in a weight loss trial.

Methods

We conducted a longitudinal cohort analysis of 338 overweight and obese women with UI enrolled in a randomized clinical trial comparing a behavioral weight loss intervention to an educational control condition. At baseline, 6, and 18?months, health utilities were estimated using the Health Utilities Index Mark 3 (HUI3), a transformation of the SF-36 to the preference-based SF-6D, and the estimated Quality of Well-Being (eQWB) score (a summary calculated from the SF-36 physical functioning, mental health, bodily pain, general health perceptions, and role limitations?Cphysical subscale scores). Potential predictors of changes in these outcomes were examined using generalized estimating equations.

Results

In adjusted multivariable models, weight loss was associated with improvement in HUI3, SF-6D, and eQWB at 6 and 18?months (P?<?0.05). Increases in physical activity also were independently associated with improvement in HUI3 (P?=?0.01) and SF-6D (P?=?0.006) scores at 18?months. In contrast, reduction in UI frequency did not predict improvements in HRQL at 6 or 18?months.

Conclusion

Weight loss and increased physical activity, but not reduction in UI frequency, were strongly associated with improvements in health utilities measured by the HUI3, SF-6D, and eQWB. These findings provide important information that can be used to inform cost?Cutility analyses of weight loss interventions.     

Comparing directly measured standard gamble scores to HUI2 and HUI3 utility scores: group- and individual-level comparisons

Directly measured standard gamble (SG) utility scores reflect the respondent's assessment and valuation of their own health status. Scores from the health utilities index (HUI) are based on self-assessed health status but valued using community preferences obtained using the SG. Our objectives were to find if mean directly measured utility scores agree with mean HUI mark 2 (HUI2) and mean HUI mark 3 (HUI3) scores. Also, if individual directly measured utility scores agree with HUI2 and HUI3 scores, and whether HUI2 and HUI3 scores agree. Questionnaires based on the HUI2 and HUI3 health-status classification systems were administered by interviewers to 140 teenage survivors of extremely low birthweight (ELBW) and 124 control group teens. Respondents were asked to think about their own usual health states using six dimensions from HUI2 and value that state using the SG. Mean SG scores are compared with mean HUI2 and mean HUI3 scores using paired sample t-tests. Mean HUI2 scores are compared with mean HUI3 scores. Agreement among scores is assessed using intra-class correlation coefficient (ICC). The effect of severity of health-state morbidity on agreement was assessed using three approaches. ELBW cohort mean (standard deviation) SG, HUI2, and HUI3 scores were 0.90 (0.20), 0.89 (0.14), and 0.80 (0.22). Results for controls were 0.93 (0.11), 0.95 (0.09), and 0.89 (0.13). Mean SG and HUI2 scores did not differ; mean SG and HUI3 did differ; mean HUI2 and HUI3 also differed. At the individual level for ELBW, the ICCs between SG and HUI2, SG and HUI3, and HUI2 and HUI3 scores were 0.13, 0.28, and 0.64. For controls the ICCs were 0.14, 0.24, and 0.56. HUI2 scores appear to match directly measured utility scores reasonably well at the group level. HUI2 and HUI3 scores differ systematically. At the individual level, however, HUI2 and HUI3 scores are poor substitutes for directly measured scores.