Skip to main content
    • Aa
    • Aa

Utilities and Quality-Adjusted Life Years

  • George W. Torrance (a1) and David Feeny (a1)

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.

Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

D. A. Albert Decision theory in medicine: A review and critique. Milbank Memorial Quarterly, 1978, 56, 362401.

M. Allais & O. Hagen (eds.). Expected utility hypotheses and the Allais Paradox. Dordrecht, Holland: Reidel, 1979.

J. P. Anderson , J. W. Bush , M. Chen & D. Dolenc Policy space areas and properties of benefit-cost/utility analysis. Journal of the American MedicalAssociation, 1986, 255, 794–95.

K. J. Arrow & G. Debreu Existence of equilibrium for a competetive economy. Econometrica 1954, 22, 265–90.

D. E. Bell & P. H. Farquhar Perspectives on utility theory. Operations Research, 1986, 34, 179–83.

C. Bombardier , J. Ware , I. J. Russell , Auranofin therapy and quality of life in patients with rheumatoid arthritis: Results of a multicenter trial. American Journal of Medicine, 1986, 81, 565–78.

M. H. Boyle , G. W. Torrance , J. C. Sinclair & S. P. Horwood Economic evaluation of neonatal intensive care of very low birth-weight infants. New England Journal of Medicine, 1983, 308, 1330–37.

D. S. Brookshire , M. A. Thayer , J. Tschirhart & W. D. Schulze A test of the expected utility model: Evidence from earthquake risks. Journal of Political Economy, 1985, 93, 369–89.

J. W. Bush , S. Fanshel & M. M. Chen Analysis of a tuberculin testing program using a health status index. Socio-Economic Planning Science, 1972, 6, 4968.

J. S. Dyer & R. K. Sarin Group preference aggregation rules based on strength of preference. Management Science, 1979, 25, 822–32.

S. Fanshel & J. W. Bush A health status index and its application to health services outcomes. Operations Research, 1970, 18, 1021–66.

P. H. Farquhar Utility assessment methods. Management Science, 1984, 30, 1283–300.

D. Feeny & G. W. Torrance Incorporating utility-based quality-of-life assessment measures in clinical trials: Two examples. Medical Care, 1989, 27 (Suppl. 3), S190–S204.

G. W. Fischer Utility models for multiple objective decisions: Do they accurately represent human preferences? Decision Sciences, 1979, 10, 451–79.

G. H. Guyatt , M. Drummond , D. Feeny , Guidelines for the clinical and economic evaluation of health care technologies. Social Science and Medicine, 1986, 22, 393408.

O. Hagen & F. Wenstop (eds.) Progress in utility and risk theory. Dordrecht, Holland: Reidel, 1984.

J. Harsanyi Nonlinear social welfare functions. Theory and Decision, 1975, 6, 311–32.

J. C. Hershey , H. C. Kunreuther & P. J. H. Schoemaker Sources of bias in assessment procedures for utility functions. Management Science, 1982, 28, 936–54.

C. Hildrith Alternative conditions for social orderings. Econometrica, 1953, 21, 8194.

R. A. Howard Decision analysis: Practice and promise. Management Science, 1988, 34, 679–95.

E. Kalai & D. Schmeidler Aggregation procedure for cardinal preferences: A formulation and proof of Samuelson's impossibility conjecture. Econometrica, 1977, 45, 1431–38.

J. P. Kassirer , A. J. Moskowitz , J. Lau & S. G. Pauker Decision analysis: A progress report. Annals of Internal Medicine, 1987, 106, 275–91.

E. B. Keeler & S. Cretin Discounting of life-saving and other nonmonetary effects. Management Science, 1983, 29, 300–06.

R. L. Keeney A group preference axiomatization with cardinal utility. Management Science, 1976, 23, 140–45.

R. L. Keeney Decision-analysis: an overview. Operations Research, 1982, 30, 803–38.

P. E. Krumins , S. O. Fihn & D. L. Kent Symptom severity and patients' values in the decision to perform a transurethral resection of the prostate. Medical Decision Making, 1988, 8, 18.

D. A. Lane Utility, decision, and quality of life. Journal of Chronic Diseases, 1987, 40, 585–91.

G. Loomes & L. McKenzie The use of QALYs in health care decision making. Social Science and Medicine, 1989, 28, 299308.

K. R. MacCrimmon & S. Larsson Utility theory: Axioms versus paradoxes. In M. Allais & O. Hagen (eds.), Expected utility and the Allais Paradox. Dordrecht, Holland: Reidel, 1979, 333409.

B. McNeil & S. G. Pauker Decision analysis for public health: Principles and illustrations. Annual Review of Public Health, 1984, 5, 135–61.

A. Mehrez & A. Gafni Quality-adjusted life years, utility theory, and healthy-years equivalents. Medical Decision Making, 1989, 9, 142–49

S. G. Pauker Coronary artery surgery: The use of decision analysis. Annals of Internal Medicine, 1976, 85, 8.

J. L. Read , R. J. Quinn , D. M. Berwick , Preferences for health outcomes: Comparison of assessment methods. Medical Decision Making, 1984, 4, 315–29.

R. Rosser & P. Kind A scale of valuations of states of illness: Is there a social consensus? International Journal of Epidemiology, 1978, 7, 347–58.

D. L. Sackett & G. W. Torrance The utility of different health states as perceived by the general public. Journal of Chronic Diseases, 1978, 31, 697704.

W. Samuelson & R. Zeckhauser Status quo bias in decision making. Journal of Risk and Uncertainty, 1988, 1, 759.

P. J. H. Schoemaker Experiments on decision under risk: The expected utility hypothesis. Boston, MA: Martinus Nijhoff, 1980.

W. B. Schwartz , G. A. Gorry , J. P. Kassirer , Decision analysis and clinical judgment. American Journal of Medicine, 1973, 55, 459.

P. Slovic & A. Tversky Who accepts Savage's axioms? Behavioral Sciences, 1974, 19, 368–73.

G. W. Torrance Social preferences for health states: An empirical evaluation of three measurement techniques. Socio-Economic Planning Sciences, 1976, 10, 129–36.

G. W. Torrance Measurement of health-state utilities for economic appraisal: A review. Journal of Health Economics, 1986, 5, 130.

G. W. Torrance Utility approach to measuring health-related quality of life. Journal of Chronic Diseases, 1987, 40, 593600.

G. W. Torrance , M. H. Boyle & S. P. Horwood Application of multi-attribute utility theory to measure social preferences for health states. Operations Research, 1982, 30, 1043–69.

M. C. Weinstein Economic assessments of medical practices and technologies. Medical Decision Making, 1981, 1, 309–30.

M. C. Weinstein & W. B. Stasson Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 1977, 296, 716–21.

A. Williams Economics of coronary artery by-pass grafting. British Medical Journal, 1985, 291, 326–29.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score