Keith Tolley

Health Economist 

Author of: What are health utilities?

Keith’s background is in health economics; he has worked both in academia (University of York – Centre for Health Economics and University of Nottingham, 1987-1997) and for several pharmaceutical companies, including GSK, Pfizer and Ortho Biotech (1997-2005) and in consultancy as a Director at Mapi Values.  Keith is currently Director of Tolley Health Economics, a company he set up in 2008 to provide strategic health economics consultancy for the market access of pharmaceuticals, and HTA submission dossier preparation and advice.

Since 2005 Keith has also been a health economics assessor with the Scottish Medicines Consortium (SMC), having previously been an industry representative on the New Drugs Committee of the SMC.  In 2013 Keith also became an assessor for the All Wales Medicine Strategy Group (AWMSG) and has provided expert advice as part of the NICE Early Scientific Advice Programme.  Keith has published extensively in health economics and is the author of two books and several edited books.  Keith has a BA and an MPhil from the University of Leeds.

Summary: What are health utilities?

  • Utilities are cardinal values that represent the strength of an individual’s preferences for specific health-related outcomes.
  • Measuring health utilities involves two main steps: defining a set of health states of interest, and valuing those health states.
  • There are direct or indirect methods of utility valuation.
  • The methods that have been used to collect data on utilities include the standard gamble approach, the time trade-off approach and the visual analogue approach.
  • The main indirect methods of utility measurement are: the use of generic preference instruments (EQ-5D, SF-6D and HUI); the use of disease-specific preference measures; and mapping from a disease-specific health-related quality of life instrument to a generic instrument.
  • Generic preference-based measures are increasingly being used in cost-utility analyses of pharmaceutical and other healthcare interventions. In the UK, the National Institute for Health and Care Excellence (NICE) has specified the EQ-5D as its preferred method of utility measurement.
  • Utilities have been used as the preference weights (quality levels) within the quality-adjusted life-year model – an increasingly popular outcome measure used by health technology assessment bodies in drug access decision-making.