Health state values from multiattribute utility instruments need correction

Cost-utility analysis uses the quality-adjusted life year (QALY) as a measu re of the benefit of health interventions. It presupposes the assignment of utility scores to different states of health on a scale from zero (dead) t o unity (healthy). A number of so-called multiattribute utility (MAU) instr uments are available for this purpose. Analysts who wish to use MAU instrum ents in economic evaluations of health programmes and technologies may impr ove their performance by conducting two different analyses: the first is a conventional cost-utility study, in which the utilities from MAU instrument s are used as they stand, and the second is a study in which the utilities are transformed into numbers that also encapsulate concerns for giving prio rity to the worst off. The term 'cost-value analysis' is used for the latte r, broader approach. A figure is offered as a preliminary tool to help cond uct the required transformations.