Health Utilities Index (HUI)

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Abstract

The Health Utilities Index (HUI) is a widely recognized, preference-based system designed to measure health-related quality of life (HRQOL) and generate utility scores. Developed by researchers at McMaster University, the HUI system includes two main comprehensive classification systems: the HUI Mark 2 (HUI2) and the HUI Mark 3 (HUI3). These instruments classify an individual’s health status across multiple dimensions, assigning weights derived from community preferences using Multi-Attribute Utility Theory (MAUT). The resulting utility scores, which range from 0.00 (death) to 1.00 (perfect health), are essential for conducting cost-utility analyses, such as calculating Quality-Adjusted Life Years (QALYs), particularly in fields like pharmacoeconomics and clinical epidemiology.

Keywords

Health Utilities Index, HUI, HUI2, HUI3, Health Status Classification, Quality-Adjusted Life Years, QALY, Multi-Attribute Utility Theory, MAUT, Health-Related Quality of Life, HRQOL, Utility Score, Pharmacoeconomics

Authors

David H. Feeny, William J. Furlong, George W. Torrance, Michael Boyle, Ronald D. Barr, John Horsman

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Purpose

The primary purpose of the Health Utilities Index (HUI) is to provide a standardized, comprehensive, and preference-based measure of overall health status. Unlike scales that only measure symptom severity or functional limitations, the HUI is specifically designed to calculate a single summary score—the utility score—that reflects the value or preference the general population places on that specific health state.

This utility measure is crucial for economic evaluations, allowing researchers and policymakers to compare the cost-effectiveness of different healthcare interventions. By generating Quality-Adjusted Life Years (QALYs), the HUI helps quantify the burden of disease and the benefits of treatment across diverse patient populations. The instrument is utilized extensively in clinical trials, population health surveys, and health economic analyses globally.

Construct

The HUI measures the construct of Health-Related Quality of Life (HRQOL) using a Multi-Attribute Health Status Classification System. Both HUI2 and HUI3 define health status across several distinct attributes or domains, each described by multiple levels of function. This multi-attribute structure allows for the classification of thousands of unique health states.

The core innovation of the HUI is its use of community-based preferences to weight these attributes. These weights are aggregated using a multiplicative scoring function, which reflects the theory that deficiencies across multiple domains have a compounding negative effect on overall health utility. The resulting utility score, therefore, integrates both the descriptive complexity of health status and the public’s valuation of those states, making it appropriate for resource allocation decisions.

The scoring formulae provided in the source material demonstrate this multiplicative structure:

  • HUI-2 Formula:

    HUI-2 = 1.06 * (Sensation * Mobility * Emotion * Cognition * Self-Care * Pain * Fertility) – 0.06

  • HUI-3 Formula:

    HUI-3 = 1.371 * (Vision * Hearing * Speech * Ambulation * Dexterity * Emotion * Cognition * Pain) – 0.371

Validity

The HUI system, particularly HUI3, has demonstrated robust psychometric properties across various populations. Content validity is supported by the comprehensive nature of the attributes chosen, which cover essential aspects of physical, sensory, and psychosocial functioning valued by the general public.

Construct validity has been established through numerous studies showing that HUI scores correlate logically with disease severity, clinical measures, and other established HRQOL instruments (e.g., SF-36), as expected by theoretical predictions. Furthermore, the HUI exhibits strong discriminant validity, effectively distinguishing between different patient groups based on known differences in health status and responsiveness to clinical change, making it a valuable outcome measure in intervention studies.

Reliability

The HUI has demonstrated high levels of test-retest reliability and inter-rater reliability, especially when administered via structured interviews or self-completion questionnaires. The standardized classification system minimizes measurement error. Studies involving pediatric and adult populations have confirmed the stability of the utility scores over time in the absence of clinical change, supporting its reliable use in longitudinal health monitoring and clinical trials.

Factor Analysis

The HUI is structured conceptually as a multi-attribute scale rather than a traditional factor-analytic scale where items load onto underlying latent factors. The HUI structure pre-specifies the dimensions (e.g., Vision, Pain, Emotion) based on clinical and community relevance. The scoring mechanism utilizes a multiplicative function, which assumes that the attributes are not independent in their impact on overall utility. This approach is rooted in decision theory and utility theory, rather than exploratory factor analysis, ensuring that the final score reflects a comprehensive integration of health limitations.

Instrument

Test Type: Multi-Attribute Utility Preference-Based Health Status Classification System

Format: Self-report questionnaire or structured interview, typically administered in approximately 5 to 10 minutes.

Language Available: Available in numerous languages (e.g., English, French, Spanish, Chinese, Japanese) due to its international use in clinical and economic research.

Population Group: General population, clinical patients, and specific disease cohorts.

Age Group: Applicable to children (with proxy reporting) and adults. HUI2 was often used for pediatric populations, while HUI3 is frequently preferred for adults.

Population Details: The preference weights used in the scoring algorithms (the utility function) were derived from surveys of large, representative samples of the general population using standard gamble and time trade-off techniques.

Test Methodology: Respondents classify their current health state across the defined attributes (e.g., 7 attributes for HUI2, 8 for HUI3). These classifications are then converted into single-attribute utility scores, which are combined via a multiplicative function to yield a final overall Utility Score (HUI index score).

Keywords

Health Measurement, QALYs, Cost-Utility Analysis, HRQOL Assessment, Preference Weights, Multiplicative Utility Function, McMaster University, Clinical Outcome Measures

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Authors

Author ORCID Identifier: N/A (Information not available in source content)

Affiliation Email addresses: N/A (Information not available in source content)

Correspondence Address: Correspondence is typically handled through the official HUI organization affiliated with McMaster University.

Permissions & Fee and Test Year

The Health Utilities Index (HUI) system is proprietary and managed by Health Utilities Inc. Use of the HUI system requires permission and typically involves licensing fees, especially for commercial research or use in large-scale clinical trials. The development of HUI2 was formalized in the mid-1990s, with key publications dating back to 1995 and 1996. HUI3 refinement and validation continued into the 2000s.

The official website for licensing and further information is: http://www.healthutilities.com/

The original PDF document referenced in the source content, providing details on measuring health, can be downloaded here: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf

Reference’s

  • Feeny, David., Furlong, William., Boyle, Michael., and Torrance, George W. (1995) “Multi-Attribute Health Status Classification Systems: Health Utilities Index.” PharmacoEconomics, 7(6); 490-502.

  • Feeny, David H., George W. Torrance, and William J. Furlong, Health Utilities Index,” Chapter 26 In Bert Spilker, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. Second Edition. Philadelphia: Lippincott-Raven Press, 1996, pp 239-252.

  • Torrance, George W., David H. Feeny, William J. Furlong, Ronald D. Barr, Yueming Zhang, and Qinan Wang. (1996). “Multi-Attribute Preference Functions for A Comprehensive Health Status Classification System: Health Utilities Index Mark 2.” Medical Care, Vol. 34, No. 7, July, pp 702-722.

  • Furlong, William J., Feeny, David H., Torrance, George W., Barr, Ronald D. (2001). The Health Utilities Index (HUI®) System for Assessing Health-Related Quality of Life in Clinical Studies, McMaster University Centre for Health Economics and Policy Analysis Research Working Paper Series # 01-02.

  • Horsman, John., Furlong, William., Feeny, David., Torrance, George. (2003). “The Health Utilities Index (HUI®): concepts, measurement properties and applications”. Health and Quality of Life Outcomes. 1: 54.

  • McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS

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Items of the Health Utilities Index (HUI)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

HUI2 Multi-Attribute Health Status Classification System
Sensation
  1. Able to see, hear and speak normally for age.
  2. Requires equipment to see or hear or speak.
  3. Sees, hears, or speaks with limitations even with equipment.
  4. Blind, deaf or mute.
Mobility
  1. Able to walk, bend, lift, jump, and run normally for age.
  2. Walks, bends, lifts, jumps, or runs with some limitations but does not require help.
  3. Requires mechanical equipment (such as canes, crutches, braces or wheelchair) to walk or get around independently.
  4. Requires the help of another person to walk or get around and requires mechanical equipment as well.
  5. Unable to control or use arms and legs.
Emotion
  1. Generally happy and free from worry.
  2. Occasionally fretful, angry, irritable, anxious, depressed, or suffering “night terrors”.
  3. Often fretful, angry, irritable, anxious, depressed, or suffering “night terrors”.
  4. Almost always fretful, angry, irritable, anxious, depressed.
  5. Extremely fretful, angry, irritable, anxious or depressed usually requiring hospitalization or psychiatric institutional care.
Cognition
  1. Learns and remembers school work normally for age.
  2. Learns and remembers school work more slowly than classmates as judged by parents and/or teachers.
  3. Learns and remembers very slowly and usually requires special educational assistance.
  4. Unable to learn and remember.
Self-Care
  1. Eats, bathes, dresses, and uses the toilet normally for age.
  2. Eats, bathes, dresses, or uses the toilet independently with difficulty.
  3. Requires mechanical equipment to eat, bathe, dress, or use the toilet independently.
  4. Requires the help of another person to eat, bathe, dress, or use the toilet.
Pain
  1. Free of pain and discomfort.
  2. Occasional pain. Discomfort relieved by non-prescription drugs or self-control activity without disruption of normal activities.
  3. Frequent pain. Discomfort relieved by oral medicines with occasional disruption of normal activities.
  4. Frequent pain; frequent disruption of normal activities. Discomfort requires prescription narcotics for relief.
  5. Severe pain. Pain not relieved by drugs and constantly disrupts normal activities.
Fertility
  1. Able to have children with a fertile spouse.
  2. Difficulty in having children with a fertile spouse.
  3. Unable to have children with a fertile spouse.
HUI3 Multi-Attribute Health Status Classification System
Vision
  1. Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, without glasses or contact lenses.
  2. Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, but with glasses.
  3. Able to read ordinary newsprint with or without glasses but unable to recognize a friend on the other side of the street, even with glasses.
  4. Able to recognize a friend on the other side of the street with or without glasses but unable to read ordinary newsprint, even with glasses.
  5. Unable to read ordinary newsprint and unable to recognize a friend on the other side of the street, even with glasses.
  6. Unable to see at all.
Hearing
  1. Able to hear what is said in a group conversation with at least three other people, without a hearing aid.
  2. Able to hear what is said in a conversation with one other person in a quiet room without a hearing aid, but requires a hearing aid to hear what is said in a group conversation with at least three other people.
  3. Able to hear what is said in a conversation with one other person in a quiet room with a hearing aid, and able to hear what is said in a group conversation with at least three other people, with a hearing aid.
  4. Able to hear what is said in a conversation with one other person in a quiet room, without a hearing aid, but unable to hear what is said in a group conversation with at least three other people even with a hearing aid.
  5. Able to hear what is said in a conversation with one other person in a quiet room with a hearing aid, but unable to hear what is said in a group conversation with at least three other people even with a hearing aid.
  6. Unable to hear at all.
Speech
  1. Able to be understood completely when speaking with strangers or friends.
  2. Able to be understood partially when speaking with strangers but able to be understood completely when speaking with people who know me well.
  3. Able to be understood partially when speaking with strangers or people who know me well.
  4. Unable to be understood when speaking with strangers but able to be understood partially by people who know me well.
  5. Unable to be understood when speaking to other people (or unable to speak at all).
Ambulation
  1. Able to walk around the neighbourhood without difficulty, and without walking equipment.
  2. Able to walk around the neighbourhood with difficulty; but does not require walking equipment or the help of another person.
  3. Able to walk around the neighbourhood with walking equipment, but without the help of another person.
  4. Able to walk only short distances with walking equipment, and requires a wheelchair to get around the neighbourhood.
  5. Unable to walk alone, even with walking equipment. Able to walk short distances with the help of another person, and requires a wheelchair to get around the neighbourhood.
  6. Cannot walk at all.
Dexterity
  1. Full use of two hands and ten fingers.
  2. Limitations in the use of hands or fingers, but does not require special tools or help of another person.
  3. Limitations in the use of hands or fingers, is independent with use of special tools (does not require the help of another person).
  4. Limitations in the use of hands or fingers, requires the help of another person for some tasks (not independent even with use of special tools).
  5. Limitations in use of hands or fingers, requires the help of another person for most tasks (not independent even with use of special tools).
  6. Limitations in use of hands or fingers, requires the help of another person for all tasks (not independent even with use of special tools).
Emotion
  1. Happy and interested in life.
  2. Somewhat happy.
  3. Somewhat unhappy.
  4. Very unhappy.
  5. So unhappy that life is not worthwhile.
Cognition
  1. Able to remember most things, think clearly and solve day to day problems.
  2. Able to remember most things, but have a little difficulty when trying to think and solve day to day problems.
  3. Somewhat forgetful, but able to think clearly and solve day to day problems.
  4. Somewhat forgetful, and have a little difficulty when trying to think or solve day to day problems.
  5. Very forgetful, and have great difficulty when trying to think or solve day to day problems.
  6. Unable to remember anything at all, and unable to think or solve day to day problems.
Pain
  1. Free of pain and discomfort.
  2. Mild to moderate pain that prevents no activities.
  3. Moderate pain that prevents a few activities.
  4. Moderate to severe pain that prevents some activities.
  5. Severe pain that prevents most activities.

Cite this article

Mohammed looti (2025). Health Utilities Index (HUI). Psychological Scales & Instruments Database. Retrieved from https://db.arabpsychology.com/scales/health-utilities-index-hui/

Mohammed looti. "Health Utilities Index (HUI)." Psychological Scales & Instruments Database, 13 Oct. 2025, https://db.arabpsychology.com/scales/health-utilities-index-hui/.

Mohammed looti. "Health Utilities Index (HUI)." Psychological Scales & Instruments Database, 2025. https://db.arabpsychology.com/scales/health-utilities-index-hui/.

Mohammed looti (2025) 'Health Utilities Index (HUI)', Psychological Scales & Instruments Database. Available at: https://db.arabpsychology.com/scales/health-utilities-index-hui/.

[1] Mohammed looti, "Health Utilities Index (HUI)," Psychological Scales & Instruments Database, vol. X, no. Y, ص Z-Z, October, 2025.

Mohammed looti. Health Utilities Index (HUI). Psychological Scales & Instruments Database. 2025;vol(issue):pages.

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