Skip to main content Accessibility help

Cost–utility analysis and otolaryngology

Published online by Cambridge University Press:  10 February 2014

D Hamilton
Northern Deanery, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
C Hulme
Academic Unit of Health Economics, University of Leeds, UK
L Flood
Department of Otolaryngology, James Cook University Hospital, Middlesbrough, UK
S Powell
Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
E-mail address:
Get access


As providers of health care, we face increasing demand on our limited, indeed diminishing, resources. Economic appraisal of our interventions means assessing the trade-off between effectiveness, efficiency and equity. When rationing becomes inevitable, calculation of utility values is a valuable decision-making tool. This paper reviews objective measures of patient benefit, such as quality of life, and focuses on their application within otolaryngology.

Review Article
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below.


1Torrance, GW. Measurement of health state utilities for economic appraisal. J Health Econ 1986;5:130CrossRefGoogle ScholarPubMed
2National Institute of Health and Clinical Excellence. Guide to the Methods for Technology Appraisal. London: National Institute of Health and Clinical Excellence, 2008Google Scholar
3Mooney, G. Economics, Medicine and Health Care, 3rd edn.Upper Saddle River, New Jersey: Prentice Hall, 2003Google Scholar
4Fischer, DW. Utility models for multiple objective decisions: do they accurately represent human preferences? Decision Sciences 1979;10:451–79CrossRefGoogle Scholar
5van der Donk, J, Levendag, PC, Kuijpers, AJ, Roest, FH, Habbema, JD, Meeuwis, CA et al. Patient participation in clinical decision-making for treatment of T3 laryngeal cancer: a comparison of state and process utilities. J Clin Oncol 1995;13:2369–78CrossRefGoogle ScholarPubMed
6Edwards, A, Elwyn, G. Shared Decision-Making in Health Care: Achieving Evidence-Based Patient Choice, 2nd edn.Oxford: Oxford University Press, 2009;xviii, 414Google Scholar
7Post, PN, Stiggelbout, AM, Wakker, PP. The utility of health states after stroke: a systematic review of the literature. Stroke 2001;32:1425–9CrossRefGoogle ScholarPubMed
8Furlong, W, Feeny, D, Torrance, GW, Barr, R, Horsman, J. Guide to the Design and Development of Health-State Utility Instrumentation. Hamilton, Ontario: McMaster University, 1990Google Scholar
9Torrance, GW, Thomas, WH, Sackett, DL. A utility maximization model for evaluation of health care programs. Health Services Research 1972;7:118–33Google ScholarPubMed
10Torrance, GW, Feeny, DH, Furlong, WJ, Barr, RD, Zhang, Y, Wang, Q. Multiattribute utility function for a comprehensive health status classification system. Health Utilities Index Mark 2. Med Care 1996;34:702–22CrossRefGoogle ScholarPubMed
11Stevens, KJ, McCabe, CJ, Brazier, JE. Mapping between Visual Analogue Scale and Standard Gamble data; results from the UK Health Utilities Index 2 valuation survey. Health Econ 2006;15:527–33CrossRefGoogle ScholarPubMed
12Martin, AJ, Glasziou, PP, Simes, RJ, Lumley, T. A comparison of standard gamble, time trade-off, and adjusted time trade-off scores. Int J Technol Assess Health Care 2000;16:137–47CrossRefGoogle ScholarPubMed
13Dolan, P, Sutton, M. Mapping visual analogue scale health state valuations onto standard gamble and time trade-off values. Social Sci Med 1997;44:1519–30CrossRefGoogle ScholarPubMed
14Parkin, D, Devlin, N. Is there a case for using visual analogue scale valuations in cost-utility analysis? Health Econ 2006;15:653–64CrossRefGoogle Scholar
15Cheng, AK, Rubin, HR, Powe, NR, Mellon, NK, Francis, HW, Niparko, JK. Cost-utility analysis of the cochlear implant in children. JAMA 2000;284:850–6CrossRefGoogle ScholarPubMed
16Roberts, RA, Abrams, H, Sembach, MK, Lister, JJ, Gans, RE, Chisolm, TH. Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo. Ear Hear 2009;30:369–76CrossRefGoogle ScholarPubMed
17de Boer, AGEM, van Lanschot, JJB, Stalmeier, PFM, van Sandick, JW, Hulscher, JBF, de Haes, JCJM et al. Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res 2004;13:311–20CrossRefGoogle ScholarPubMed
18Brazier, J, Deverill, M, Green, C, Harper, R, Booth, A. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999;3:i–iv, 1164Google ScholarPubMed
19Arnesen, TM, Norheim, OF. Quantifying quality of life for economic analysis: time out for time tradeoff. Med Humanit 2003;29:81–6CrossRefGoogle ScholarPubMed
20McNeil, BJ, Weichselbaum, R, Pauker, SG. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. N Engl J Med 1981;305:982–7CrossRefGoogle Scholar
21Summerfield, AQ, Marshall, DH, Barton, GR, Bloor, KE. A cost-utility scenario analysis of bilateral cochlear implantation. Arch Otolaryngol Head Neck Surg 2002;128:1255–62CrossRefGoogle ScholarPubMed
22Jalukar, V, Funk, GF, Christensen, AJ, Karnell, LH, Moran, PJ. Health states following head and neck cancer treatment: patient, health-care professional, and public perspectives. Head Neck 1998;20:600–83.0.CO;2-1>CrossRefGoogle ScholarPubMed
23Gafni, A. The standard gamble method: what is being measured and how it is interpreted. Health Serv Res 1994;29:207–24Google ScholarPubMed
24McNamee, P, Glendinning, S, Shenfine, J, Steen, N, Griffin, SM, Bond, J. Chained time, trade-off and standard gamble, methods. Applications in oesophageal cancer. Eur J Health Econ 2004;5:81–6Google ScholarPubMed
25Hammerschmidt, T, Zeitler, H-P, Gulich, M, Leidl, R. A comparison of different strategies to collect standard gamble utilities. Med Decis Making 2004;24:493503CrossRefGoogle ScholarPubMed
26Juniper, EF, Thompson, AK, Roberts, JN. Can the standard gamble and rating scale be used to measure quality of life in rhinoconjunctivitis? Comparison with the RQLQ and SF-36. Allergy 2002;57:201–6CrossRefGoogle ScholarPubMed
27EuroQol Group. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199208CrossRefGoogle Scholar
28Dolan, P. Modeling valuations for EuroQol health states. Med Care 1997;35:1095–108CrossRefGoogle ScholarPubMed
29Roberts, J, Dolan, P. To what extent do people prefer health states with higher values? A note on evidence from the EQ-5D valuation set. Health Econ 2004;13:733–7CrossRefGoogle ScholarPubMed
30Hol, MKS, Spath, MA, Krabbe, PFM, van der Pouw, CTM, Snik, AFM, Cremers, CWRJ et al. . The bone-anchored hearing aid: quality-of-life assessment. Arch Otolaryngol Head Neck Surg 2004;130:394–9CrossRefGoogle ScholarPubMed
31Powell, SM, Tremlett, M, Bosman, DA. Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy. J Laryngol Otol 2011;125:193–8CrossRefGoogle ScholarPubMed
32Hopkins, C, Fairley, J, Yung, M, Hore, I, Balasubramaniam, S, Haggard, M. The 14-item Paediatric Throat Disorders Outcome Test: a valid, sensitive, reliable, parent-reported outcome measure for paediatric throat disorders. J Laryngol Otol 2010;124:306–14CrossRefGoogle ScholarPubMed
33McNeil, ML, Gulliver, M, Morris, DP, Bance, M. Quality of life improvement for bone-anchored hearing aid users and their partners. J Laryngol Otol 2011;125:554–60CrossRefGoogle ScholarPubMed
34Robinson, K, Gatehouse, S, Browning, GG. Measuring patient benefit from otorhinolaryngological surgery and therapy. Ann Otol Rhinol Laryngol 1996;105:415–22CrossRefGoogle ScholarPubMed
35Drummond, MF, Iglesias, CP, Cooper, NJ. Systematic reviews and economic evaluations conducted for the National Institute for Health and Clinical Excellence in the United Kingdom: a game of two halves? Int J Technol Assess Health Care 2008;24:146–50CrossRefGoogle ScholarPubMed
36Rowen, D, Brazier, J, Young, T, Gaugris, S, Craig, BM, King, MT et al. Deriving a preference-based measure for cancer using the EORTC QLQ-C30. Value Health 2011;14:721–31CrossRefGoogle ScholarPubMed
37Rowen, D, Brazier, J, Roberts, J. Mapping SF-36 onto the EQ-5D index: how reliable is the relationship? Health Qual Life Outcomes 2009;7:27CrossRefGoogle ScholarPubMed
38Monksfield, P, Jowett, S, Reid, A, Proops, D. Cost-effectiveness analysis of the bone-anchored hearing device. Otol Neurotol 2011;32:1192–7CrossRefGoogle ScholarPubMed
39Higgins, KM. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 2011;121:116–34CrossRefGoogle ScholarPubMed
40Dedhia, RC, Smith, KJ, Johnson, JT, Roberts, M. The cost-effectiveness of community-based screening for oral cancer in high-risk males in the United States: a Markov decision analysis approach. Laryngoscope 2011;121:952–60CrossRefGoogle ScholarPubMed
41Cooper, JD, Smith, KJ, Ritchey, AK. A cost-effectiveness analysis of coagulation testing prior to tonsillectomy and adenoidectomy in children. Pediatr Blood Cancer 2010;55:1153–9CrossRefGoogle ScholarPubMed
42Lock, C, Wilson, J, Steen, N, Eccles, M, Mason, H, Carrie, S et al. North of England and Scotland Study of Tonsillectomy and Adeno-tonsillectomy in Children (NESSTAC): a pragmatic randomised controlled trial with a parallel non-randomised preference study. Health Technol Assess 2010;14: iii–iv, 1164Google ScholarPubMed
43Morrison, D. Management of patients with acoustic neuromas: a Markov decision analysis. Laryngoscope 2010;120:783–90CrossRefGoogle ScholarPubMed
44Chao, TK, Chen, TH. Cost-effectiveness of hearing aids in the hearing-impaired elderly: a probabilistic approach. Otol Neurotol 2008;29:776–83CrossRefGoogle ScholarPubMed
45Heiba, MH, Atef, A, Mosleh, M, Mohamed, R, El-Hamamsy, M. Comparison of peritonsillar infiltration of tramadol and lidocaine for the relief of post-tonsillectomy pain. J Laryngol Otol 2012;126:1138–41CrossRefGoogle ScholarPubMed
46Zhu, ZH, Zheng, J, Ying, LY, Zhu, BW, Qian, J, Ma, ZX. Cross-over study of topical anaesthesia with tetracaine solution for transoral rigid laryngoscopy. J Laryngol Otol 2012;126:1150–4CrossRefGoogle ScholarPubMed
47Haxel, BR, Bertz-Duffy, S, Fruth, K, Letzel, S, Mann, WJ, Muttray, A. Comparison of subjective olfaction ratings in patients with and without olfactory disorders. J Laryngol Otol 2012;126:692–7CrossRefGoogle ScholarPubMed
48Andreou, N, Hadjisymeou, S, Panesar, J. Does tonsillectomy improve quality of life in adults? A systematic literature review. J Laryngol Otol 2013:127:332–8CrossRefGoogle ScholarPubMed
49Maile, EJ, Youngs, R. Quality of life measures in otitis media. J Laryngol Otol 2013;127:442–7CrossRefGoogle ScholarPubMed

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 15
Total number of PDF views: 78 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 22nd January 2021. This data will be updated every 24 hours.

Hostname: page-component-76cb886bbf-pdn9z Total loading time: 0.32 Render date: 2021-01-22T16:55:17.885Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false }

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Cost–utility analysis and otolaryngology
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Cost–utility analysis and otolaryngology
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Cost–utility analysis and otolaryngology
Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *