Evaluation of options for presenting health-states from PROMIS® item banks for valuation exercises

Janel Hanmer*, David Cella, David Feeny, Baruch Fischhoff, Ron D. Hays, Rachel Hess, Paul A. Pilkonis, Dennis Revicki, Mark Roberts, Joel Tsevat, Lan Yu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Purpose: Health status descriptive systems based on item response theory (IRT), such as the Patient-Reported Outcomes Measurement Information System (PROMIS®), have item banks to measure domains of health. We developed a method to present such banks for health-state valuation. Methods: We evaluated four different presentation approaches: a single item (1S), 2 items presented separately (2S), 2 items presented together (2T), or 5 items presented together (5T). We evaluated these four approaches in three PROMIS item banks (depression, physical function, and sleep disturbance). Adult community members valued health-state descriptions using the visual analog scale and standard gamble methods. We compared the approaches by the range of item bank theta scores captured, participants’ assessments of difficulty (1 = very easy to 7 = very hard), and exit interviews. Results: Participants (n = 118) ranged in age from 18 to 71; 63% were female and 54% were white. The 1S approach captured the smallest range of theta scores. A monotonic relationship between theta score and mean standard gamble estimate was found with all approaches except 2S. Across all 3 item banks, mean difficulty assessments were 2.35 (1S), 2.69 (2T), 2.78 (5T), and 2.80 (2S). In exit interviews, participants generally found all four approaches similarly meaningful and realistic. Conclusions: Creating health descriptions by presenting 2 items maximized the range of theta while minimizing difficulty and maintaining a monotonic relationship with utility estimates. We recommend this approach for valuation of IRT-based descriptive systems such as PROMIS.

Original languageEnglish (US)
Pages (from-to)1835-1843
Number of pages9
JournalQuality of Life Research
Issue number7
StatePublished - Jul 1 2018


  • Health-state descriptions
  • Preference-based scores
  • Utilities
  • Valuation of health-states

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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