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Developing cost-effectiveness health measures


Professor John Brazier and his colleagues at the University’s School of Health and Related Research (ScHARR) have developed the SF-6D preference-based health index for use in clinical trials and other studies. The SF-6D has been commercially available since 2006, through Quality Metric, a US company specialising in measuring health outcomes, and Fusion IP, the university research commercialisation company.


The SF-6D is derived from the most widely used patient-reported measure of health in the world, the SF36. Although there are eight dimensions in the SF36, these can’t be traded off against one another. For example, the relationship between pain and physical functioning, or between quality and length of life. These are needed to calculate Quality Adjusted Life Years (QALYs) and assess cost-effectiveness.

These values for comparison are provided by the SF-6D’s single index, making it possible to work out the cost per QALY. Data is collected during clinical trials and other health studies. People report how they feel their health is in areas like mobility, self-care, impact on work and social activities, pain, energy, depression and anxiety. Analysis using the SF-6D software provides an important input into the evaluation of affordability that informs decisions about whether an intervention should be made available in a health system or not.

The benefits of SF-6D

Several advantages over the previously used main health measure of cost-effectiveness, the EQ-5D, are offered by the SF-6D. It includes a richer descriptive system, better sensitivity to health changes for milder states, and covers a broader range of health dimensions.

Because the SF-36 is often used in the early stages of research, it is useful for calculating QALYs and has been taken up around the world, in North America, Australia, the Far East and Europe. Organisations that have bought the licence range from pharmaceutical companies to research organisations and hospitals.

More than 400 licences have been sold in just the last two years. Quality Metric is well-positioned in the centre of the marketplace and has a global reach. It sells SF-6D as an option with the package that includes SF36 and SF12. Fusion IP promotes the licence and is renegotiating the deal with Quality Metric.

Future plans

Income generated from licensing the SF-6D is supporting research work for an updated version. In two to three years, this new version will replace the current measure. Professor Brazier is confident that the measure adds value to the health evaluation field: “The SF-6D is an easy-to-use single-index measure of benefit that you can then compare to the cost. There is still plenty of space in the market – people are often looking for something else.”

Researchers at ScHARR are developing similar QALY products for specific populations and conditions, which are also being made commercially available through Fusion IP. These include a measure for children (CHU-9D), and measures for cancer, asthma, overactive bladder and mental health.