Multiattribute Structure for QALYs

Health status is inherently a multiattribute construct. We examine multiattribute utility decompositions for the quality-adjusted life year (QALY) utility model commonly employed in medical decision and cost-effectiveness analyses. We consider several independence conditions on preference, including the classical notions of preferential independence and utility independence, as well as new related notions of standard-gamble independence and time-tradeoff independence. The latter conditions are helpful in simplifying standard-gamble utility assessment procedures and time-tradeoff assessment procedures in the presence of multiple health attributes. Under the QALY model, all these conditions are equivalent and result in a purely multiplicative decomposition of utility over health states.