Social Evaluation of Health Care Versus Personal Evaluation of Health States:Evidence on the Validity of Four Health-state Scaling Instruments Using Norwegian and Australian Surveys

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Abstract
In most of the cost-utility literature, quality-adjusted life-year (QALY) gains are interpreted as a measure of social value. Given this interpretation, the validity of different multi-attribute health-state scaling instruments may be tested by comparing the values they provide on the 0–1 QALY scale with directly elicited preferences for person trade-offs between different treatments (equivalence of numbers of different patients treated). Norwegian and Australian public preferences as measured by the person trade-off suggest that the EuroQol Instrument assigns excessively low values to health states. This seems to be even more true of the McMaster Health Classification System. The Quality of Well-being Scale appears to compress states toward the middle of the 0–1 scale. By contrast, the Rosser/Kind index fits reasonably well with directly measured person trade-off data.