Development of goal-sensitive health-related utility assessment procedures

Purpose. To measure the degree to which people express willingness to trade life or health for nonmedical goals. Method. In 3 studies, outpatients provided important life goals. In study 1, patients performed time-tradeoff between life-years and goal achievement and chose between states that varied in goal achievement, life expectancy, and disability; in study 2, patients made choices that traded off health state and goal achievement; in study 3, patients performed time-tradeoff assessments in 3 different goal achievement contexts. Results. In study 1 (n = 58), participants were eager to trade life-years for goal achievement, trading, on average, 71% of their remaining life for certain achievement v. certain nonachievement or 54% of their remaining life for their expected likelihood of achievement v. nonachievement. Life expectancy, disability status, and goal achievement each had a significant main effect on utility. In study 2 (n = 54), participants equally preferred a moderately impaired health state with goal achievement to perfect health without goal achievement and more strongly preferred the moderately impaired state with goal achievement than other less impaired states without goal achievement. Study 3 (n = 62) demonstrated that the mere discussion of goals and goal achievement or nonachievement in the context of a standard time-tradeoff assessment (without trading off goals) did not impact the assessment. Conclusions. Nonmedical life goals are important determinants of quality of life. People express willingness to trade off life and health in pursuit of these goals, which are extrinsic to the standard quality-adjusted life-year model.