Validity of Standard Gamble Utilities as Measured by Transplant Readiness in Lung Transplant Candidates

Purpose. To evaluate the validity of standard gamble (SG)utilities, by comparing utilities with decision-making behavior in a group of lung transplant candidates facing a risky health decision. Methods. The authors elicited SG utilities for current health from 57 transplant candidates. They assessed the concordance between utility scores and patients' self-reported readiness to be placed on the transplant waiting list(“listed”). Because transplantation represents a real-life gamble with a short-term survival probability of 85%, the authors defined their minimum validity criterion as utility for current health 0.85 in transplant-ready patients. Results. Utilities were significantly higher in patients who were not ready for listing (n = 22, median utility = 0.79, range 0.06-1) than in those who were ready or listed (n = 35, median utility = 0.50, range 0-0.85, P < 0.00005). All transplant-ready patients had utilities 0.85 for current health. Conclusions. Low SG utilities were associated with transplant readiness in this population of lung transplant candidates. These results provide one line of evidence supporting the validity of SG utilities as a measure of health-related quality of life, using the criterion of decision-making behavior.