ObjectiveThe purpose of this paper was to report tests of the validity and reliability of a new instrument, the Assessment of Quality of Life (AQoL)-8D, which was constructed to improve the evaluation of health services that have an impact upon the psychosocial aspects of the quality of life.MethodsAustralian and US data from a large multi-instrument comparison survey were used to conduct tests of convergent, predictive and content validity using as comparators five other multi-attribute utility (MAU) instruments—the EQ-5D, SF-6D, Health Utilities Index (HUI) 3, 15D and the Quality of Well-Being (QWB)—as well as four non-utility instruments—the SF-36 and three measures of subjective well-being (SWB). A separate three part Australian survey was used to assess test–retest reliability.ResultsResults indicate that AQoL-8D correlates more highly with both the SWB instruments and the psychosocial dimensions of the SF-36, and that it is similar to the other MAU instruments in terms of its convergent and predictive validity. The second Australian survey demonstrated high test–retest reliability.ConclusionsThe results indicate that the AQoL-8D is a reliable and valid instrument which offers an alternative to the MAU instruments presently used in economic evaluation studies, and one which is particularly suitable when psychosocial elements of health are of importance.

BackgroundMulti attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument.MethodsThe AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements.Results and DiscussionThe resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model.ConclusionsThe AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.

The AQoL-8D is a suitable instrument for researchers conducting cost utility analyses generally but, in particular, for the analysis of services affecting psycho-social health.

Results indicate that instruments measure related but different constructs. They imply that commonly used instruments systematically discriminate against some classes of services, most notably mental health services. Differences in the instrument scales imply the need for transformations between the instruments to increase the comparability of measurement.

Statistical results indicate that the AQoL-6D can be validly used in the economic evaluation of both the OPIC interventions and other adolescent programs.