Condition-specific Preference-based Measure Research Articles

What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings.

Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted. In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains. A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual). Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

Developing the health state classification system for a condition-specific preference-based measure for patients with myasthenia gravis

Purpose This study aimed to generate the health state classification system (HCS) of a condition-specific preference-based measure to capture the health-related quality of life (HRQoL) of patients with myasthenia gravis (MG) from the 15-item Myasthenia Gravis Quality of Life Scale (MG-QoL15r). Materials and methods An HCS was derived from the MG-QoL15r in a large sample of 1739 patients with MG based on psychometric analysis, including factor analysis, item response theory analysis, and discussions with experts. Reliability, construct and convergent validity, and item fit of the HCS were further assessed using another sample. Results The HCS has six dimensions: social activity, hobbies and fun activities, meeting family needs, work performance, mobility, and emotion, and it demonstrates good internal consistency reliability. The unidimensionality of the HCS was confirmed using confirmatory factor analysis. Satisfied convergent validity was supported by a significant association with the 12-item Short Form Survey (SF-12). Conclusions Based on a solid process of development and consultations with clinical professionals and patients, a valid MG-specific preference-based measure, MGQoL-6D, was developed. Further research will estimate the local preference weight to support the MG-related cost–utility analysis. IMPLICATION FOR REHABILITATION A new condition-specific health state classification system (HCS) named Myasthenia gravis Quality of Life Scale (MGQoL-6D) is proposed. MGQoL-6D classifies MG health states as a combination of six dimensions with three response levels. The dimensions of the HCS are social activity, hobbies and fun activity, family needs, work performance, mobility, and emotion. The HCS and the upcoming value set of the MGQoL-6D could support the cost-effectiveness analysis of MG-related clinical and rehabilitated interventions.

Development and Critical Evaluation of a Condition-Specific Preference-Based Measure Sensitive to Binaural Hearing in Adults: The York Binaural Hearing-Related Quality-of-Life System.

The widely-used generic preference-based measures of health-related quality of life-the EuroQol Descriptive System (EQ-5D) and the Health Utilities Index (HUI3)-are limited in their response to technologies that improve hearing. The EQ-5D lacks construct validity for hearing, while the HUI3 is restricted by a ceiling effect and by using speech reception as the only evidence of the ability to hear. Consequently, neither measure consistently registers benefits from binaural hearing, such as those from bilateral versus unilateral cochlear implantation. The objectives were to test whether informants value binaural hearing, to develop a condition-specific preference-based measure sensitive to binaural hearing, to assess the psychometric properties of the new instrument, and to determine whether it meets requirements for informing judgments of cost-effectiveness: does it measure greater gains than do the generic preference-based measures, while avoiding exaggerating losses, and displaying sensitivity to side effects? Three levels of function, ranging from no difficulty to great difficulty, were defined on each of three dimensions where listening is easier or more successful when hearing is binaural rather than monaural: perception of speech in spatially separated noise, localization of sounds, and effort and fatigue. Informants (N = 203) valued the 27 combinations of levels and dimensions in a time trade-off task with a 10-year time frame to provide a value of binaural-related quality of life ("binaural utility") for each combination. A questionnaire was compiled to allow respondents to report their level of function on each dimension so that a value of binaural utility could be assigned to them. The questionnaire and the age-standardized valuations constitute The York Binaural Hearing-Related Quality-of-Life System (YBHRQL). Adult users of unilateral implants (N = 8), bilateral implants (N = 11), or bimodal aiding (N = 9) undertook performance tests of spatial listening and completed the HUI3, EQ-5D, and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires. They completed the YBHRQL questionnaire 24 and 38 mo later. Despite long intervals between measurements, the YBHRQL demonstrated desirable psychometric properties: good construct validity evidenced by significant correlations with performance measures and the SSQ index; a greater ability than the EQ-5D or HUI3 to distinguish unilateral, bimodal, and bilateral listening; and good reproducibility. The YBHRQL did not exaggerate losses of utility but was insensitive to a potential side effect of implantation (pain/discomfort). It measured a gain in utility from bilateral compared with unilateral implantation (median = 0.11, interquartile range, 0.03 to 0.16) that was greater than the gain measured by the EQ-5D (0.00, 0.00 to 0.00) but not the HUI3 (0.00, 0.00 to 0.17). The YBHRQL summarizes the contribution of binaural hearing to quality of life by combining the functional status of a listener with the preferences of independent informants. It would be an efficient clinical outcome measure. In addition, if used alongside the EQ-5D or HUI3, it would provide evidence which could beneficially modulate confidence in the cost-effectiveness of interventions. Further research on its sensitivity to side effects, and on the size of the gains in utility which it measures, is needed to determine whether it could stand alone to inform resource-allocation decisions.

PR1 Comparison of the Psychometric Performance of a New Condition-Specific Preference-Based Measure Derived from the Cfq-R (CFQ-R-8D) to EQ-5D-3L and SF-6D to Evaluate Health-Related Quality-of Life (HRQOL) in People with Cystic Fibrosis (CF)

PR1 Comparison of the Psychometric Performance of a New Condition-Specific Preference-Based Measure Derived from the Cfq-R (CFQ-R-8D) to EQ-5D-3L and SF-6D to Evaluate Health-Related Quality-of Life (HRQOL) in People with Cystic Fibrosis (CF)

Selection and validation of a classification system for a child-centred preference-based measure of oral health-related quality of life specific to dental caries

BackgroundCaries Impacts and Experiences Questionnaire for Children (CARIES-QC) is a child-centred caries-specific quality of life measure. This study aimed to select, and validate with children, a classification system for a paediatric condition-specific preference-based measure, based on CARIES-QC.MethodsFirst, a provisional classification system for a preference-based measure based on CARIES-QC was identified using Rasch analysis, psychometric testing, involvement of children and parents, and the developer of CARIES-QC. Second, qualitative, semi-structured ‘think aloud’ validation interviews were undertaken with a purposive sample of children with dental caries. The interviewer aimed to identify whether items were considered important and easily understood, whether any were overlapping and if any excluded items should be reintroduced. Interview recordings were transcribed verbatim and thematic analysis conducted.ResultsRasch analysis identified poor item spread for the items ‘cross’ and ‘school’. Items relating to eating were correlated and the better performing items were considered for selection. Children expressed some confusion regarding the items ‘school’ and ‘food stuck’. Parent representatives thought that impacts surrounding toothbrushing (‘brushing’) were encompassed by the item ‘hurt’. Five items were selected from CARIES-QC for inclusion in the provisional classification system; ‘hurt’, ‘annoy’, ‘carefully’, ‘kept awake’ and ‘cried’. Validation interviews were conducted with 20 children aged 5–16 years old. Participants thought the questionnaire was straightforward and covered a range of impacts. Children thought an item about certain foods being ‘hard to eat’ was more relevant than one about having to eat more carefully because of their teeth and so the ‘carefully’ item was replaced with ‘hard to eat’.ConclusionFollowing child-centred modification, the preliminary five-item classification system is considered valid and suitable for use in a valuation survey. The innovative child-centred methods used to both identify and validate the classification system can be applied in the development of other preference-based measures.

One Method, Many Methodological Choices: A Structured Review of Discrete-Choice Experiments for Health State Valuation

Discrete-choice experiments (DCEs) are used in the development of preference-based measure (PBM) value sets. There is considerable variation in the methodological approaches used to elicit preferences. Our objective was to carry out a structured review of DCE methods used for health state valuation. PubMed was searched until 31 May 2018 for published literature using DCEs for health state valuation. Search terms to describe DCEs, the process of valuation and preference-based instruments were developed. English language papers with any study population were included if they used DCEs to develop or directly inform the production of value sets for generic or condition-specific PBMs. Assessment of paper quality was guided by the recently developed Checklist for Reporting Valuation Studies. Data were extracted under six categories: general study information, choice task and study design, type of designed experiment, modelling and analysis methods, results and discussion. The literature search identified 1132 published papers, and 63 papers were included in the review. Paper quality was generally high. The study design and choice task formats varied considerably, and a wide range of modelling methods were employed to estimate value sets. This review of DCE methods used for developing value sets suggests some recurring limitations, areas of consensus and areas where further research is required. Methodological diversity means that the values should be seen as experimental, and users should understand the features of the value sets produced before applying them in decision making.

Health State Values Derived from People with Multiple Sclerosis for a Condition-Specific Preference-Based Measure: Multiple Sclerosis Impact Scale-Eight Dimensions-Patient Version (MSIS-8D-P).

In economic evaluation, health outcomes are commonly quantified using quality-adjusted life-years (QALYs) derived from the preferences of a sample of the general population. It can be argued that this approach ignores the preferences of people with experience of the condition, and that patient preferences have a place in the valuation of health outcomes. Here we report the estimation of a preference-based index for an existing condition-specific preference-based measure for multiple sclerosis (MS), the MSIS-8D, based on the preferences of people with MS. Internet time trade-off (TTO) survey, eliciting preferences from people with MS. We elicited preferences from a sample of people with MS (N = 1635) across 169 MSIS-8D health states, using the TTO technique. We fitted ordinary least squares and random effects models to the survey data to estimate values for all health states described by the MSIS-8D. The new patient-derived index (the MSIS-8D-P) provides values ranging from 0.893 for the best possible health state to 0.138 for the worst state. The MSIS-8D-P exhibits good discriminative validity, identifying expected significant differences between groups based on presence/absence of MS, type of MS, and duration since diagnosis. The MSIS-8D-P index of values for MS-specific health states provides an opportunity to estimate QALYs based on patient preferences, for use in economic evaluations of treatments for MS. More broadly, it adds to the methods and data available to consider the health-related quality of life of people with MS to inform resource allocation and individual-level decisions regarding treatments for MS.

The Role of Condition-Specific Preference-Based Measures in Health Technology Assessment.

A condition-specific preference-based measure (CSPBM) is a measure of health-related quality of life (HRQOL) that is specific to a certain condition or disease and that can be used to obtain the quality adjustment weight of the quality-adjusted life-year (QALY) for use in economic models. This article provides an overview of the role and the development of CSPBMs, and presents a description of existing CSPBMs in the literature. The article also provides an overview of the psychometric properties of CSPBMs in comparison with generic preference-based measures (generic PBMs), and considers the advantages and disadvantages of CSPBMs in comparison with generic PBMs. CSPBMs typically include dimensions that are important for that condition but may not be important across all patient groups. There are a large number of CSPBMs across a wide range of conditions, and these vary from covering a wide range of dimensions to more symptomatic or uni-dimensional measures. Psychometric evidence is limited but suggests that CSPBMs offer an advantage in more accurate measurement of milder health states. The mean change and standard deviation can differ for CSPBMs and generic PBMs, and this may impact on incremental cost-effectiveness ratios. CSPBMs have a useful role in HTA where a generic PBM is not appropriate, sensitive or responsive. However, due to issues of comparability across different patient groups and interventions, their usage in health technology assessment is often limited to conditions where it is inappropriate to use a generic PBM or sensitivity analyses.

Involving Members of the Public in Health Economics Research: Insights from Selecting Health States for Valuation to Estimate Quality-Adjusted Life-Year (QALY) Weights

Over recent years, public involvement in health research has expanded considerably. However, public involvement in designing and conducting health economics research is seldom reported. Here we describe the development, delivery and assessment of an approach for involving people in a clearly defined piece of health economics research: selecting health states for valuation in estimating quality-adjusted life-years (QALYs). This involvement formed part of a study to develop a condition-specific preference-based measure of health-related quality of life, the Multiple Sclerosis Impact Scale (MSIS-8D), and the work reported here relates to the identification of plausible, or realistic, health states for valuation. An Expert Panel of three people with multiple sclerosis (MS) was recruited from a local involvement network, and two health economists designed an interactive task that enabled the Panel to identify health states that were implausible, or unlikely to be experienced. Following some initial confusion over terminology, which was resolved by discussion with the Panel, the task worked well and can be adapted to select health states for valuation in the development of any preference-based measure. As part of the involvement process, five themes were identified by the Panel members and the researchers which summarised our experiences of public involvement in this health economics research example: proportionality, task design, prior involvement, protectiveness and partnerships. These are described in the paper, along with their practical implications for involving members of the public in health economics research. Our experience demonstrates how members of the public and health economists can work together to improve the validity of health economics research. Plain Language Summary It has become commonplace to involve members of the public in health service research. However, published reports of involving people in designing health economics research are rare. We describe how we designed a way of involving people in a particular piece of health economics research.The aim of the work was to produce descriptions of different states of health experienced by people with multiple sclerosis (MS). These descriptions have since been rated in terms of how good or bad they are in a way that can be used by the National Institute for Health and Care Excellence (NICE) to make decisions about what services to fund on the NHS.We formed a panel of three people with MS, and designed a task to help the group produce health descriptions likely to be experienced by people with MS. After discussion about jargon, and working together to find more layman's terms, the task worked well, and can be adapted to produce health descriptions for any condition.We identified some key themes about working together that give insights into how members of the public can be involved in health economics research, and show the importance of their involvement in improving the relevance of this research.

A Systematic Review of the Literature on the Development of Condition-Specific Preference-Based Measures of Health.

Health state utility values (HSUVs) are required to calculate quality-adjusted life-years (QALYs). They are frequently derived from generic preference-based measures of health. However, such generic measures may not capture health attributes of relevance to specific conditions. In such cases, a condition-specific preference-based measure (CSPBM) may be more appropriate. This systematic review aimed to identify all published accounts of developing CSPBMs to describe and appraise the methods used. We undertook a systematic search (of Embase, MEDLINE, PsycINFO, Web of Science, the Cochrane Library, CINAHL, EconLit, ASSIA and the Health Management Information Consortium database) to identify published accounts of CSPBM development up to July 2015. Studies were reviewed to investigate the methods used to design classification systems, estimate HSUVs, and validate the measures. A total of 86 publications were identified, describing 51 CSPBMs. Around two-thirds of these were QALY measures; the remainder were designed for clinical decision making only. Classification systems for 33 CSPBMs were derived from existing instruments; 18 were developed de novo. HSUVs for 34 instruments were estimated using a 'composite' approach, involving statistical modelling; the remainder used a 'decomposed' approach based on multi-attribute utility theory. Half of the papers that described the estimation of HSUVs did not report validating their measures. Various methods have been used at all stages of CSPBM development. The choice between developing a classification system de novo or from an existing instrument may depend on the availability of a suitable existing measure, while the choice between a decomposed or composite approach appears to be determined primarily by the purpose for which the instrument is designed. The validation of CSPBMs remains an area for further development.

Deriving a Preference-Based Measure for Myelofibrosis from the EORTC QLQ-C30 and the MF-SAF

BackgroundUtility values are required for economic evaluation using cost-utility analyses. Often, generic measures such as the EuroQol five-dimensional questionnaire are used, but this may not appropriately reflect the health-related quality of life of patients with cancer including myelofibrosis. ObjectiveTo derive a condition-specific preference-based measure for myelofibrosis using appropriate existing measures, the Myelofibrosis-Symptom Assessment Form and the European Organisation for Research and Treatment of Cancer Quality of Life 30 Questionnaire. MethodsData from the Controlled Myelofibrosis Study with Oral JAK Inhibitor Treatment trial (n = 309) were used to derive the health state classification system. Psychometric and factor analyses were used to determine the dimensions of the classification system. Psychometric and Rasch analyses were then used to select an item to represent each dimension. Item selection was validated with experts. A selection of health states was valued by members of the general population using time trade-off. Finally, health state values were modeled using regression analysis to produce utility values for every state. ResultsThe Myelofibrosis 8 dimensions has eight dimensions: physical functioning, emotional functioning, fatigue, itchiness, pain under ribs on the left side, abdominal discomfort, bone or muscle pain, and night sweats. Regression models were estimated using time trade-off data from 246 members of the general population valuing a total of 33 states. The best performing model was a random effects maximum likelihood model producing utility values ranging from 0.089 to 1. ConclusionsThe Myelofibrosis 8 dimensions is a condition-specific preference-based measure for myelofibrosis. This measure can be used to generate utility values for myelofibrosis for any data set containing the Myelofibrosis-Symptom Assessment Form and the European Organisation for Research and Treatment of Cancer Quality of Life 30 Questionnaire data.

1143P - A Comparison of General Population and Patient Utility Values for Advanced Melanoma

ABSTRACT Background Health-related quality of life (HRQL) is a fundamental part of health technology assessment. Utility values are vital because they can be used as preference weights and allow the calculation of HRQL benefits. The objective of this study was to compare utilities calculated for patients with advanced melanoma in the Phase III clinical trial for ipilimumab (MDX010-20) using a generic and a condition-specific preference-based measure to utilities produced by vignettes for advanced melanoma. A secondary objective was to determine how different analyses might be used most appropriately within cost-effectiveness modelling. Methods The trial utilities were generated using the condition-specific EORTC-8D (1,190 observations) and generic SF-6D (1,157 observations) preference-based measures. Progression-status and time-to-death analyses were conducted on the patient-level data and the predictive abilities were compared. Patient-level results were compared to the utilities derived for progression status using vignettes valued by the general population. Results On disease progression, vignette-generated utilities showed a greater decrease (0.77 to 0.59) than either the generic SF-6D (0.64 to 0.619) or condition-specific EORTC-8D (0.801 to 0.763). SF-6D and EORTC-8D showed a large decrease in utility in the 180 days prior to death (from 0.826 to 0.628 and from 0.655 to 0.505, respectively). Compared to progression status, time to death showed a lower Root Mean Squared Error and higher R2 when used to predict patient utility. Conclusion Practitioners should carefully analyse patient level utility data prior to constructing economic models as standard measures, such as progression status, may not fully capture the patient experience. Similarly, where vignettes are valued to represent health states in an economic model, their applicability to the disease and patient population should be carefully scrutinised. The use of standard progression based cost-effectiveness modelling techniques may not be appropriate for this disease. Consequently, there are implications for the analysis of utility information in future studies and the methods of cost-effectiveness modelling used for cancer treatments. Disclosure A. Batty: BresMed were funded by BMS to conduct the analysis presented within this paper. Other than this I have not received any personal funding and do not have any personal interest in BMS or any competitor products. B. Winn: BresMed were funded by BMS to conduct the analysis presented within this paper. Other than this I have not received any personal funding and do not have any personal interest in BMS or any competitor products. L. Pericleous: I have worked for BMS. Other than this I have not received any personal funding and do not have any personal interest in BMS or any competitor products. D. Lee: BresMed were funded by BMS to conduct the analysis presented within this paper. Other than this I have not received any personal funding and do not have any personal interest in BMS or any competitor products. T. Nikoglou: I work for BMS. Other than this I have not received any personal funding and do not have any personal interest in BMS or any competitor products. All other authors have declared no conflicts of interest.

Development of the EXACT-U: A Preference-Based Measure to Report COPD Exacerbation Utilities

Background The exacerbations of chronic obstructive pulmonary disease tool (EXACT) is a condition-specific daily diary recently developed to evaluate the frequency, severity, and duration of chronic obstructive pulmonary disease (COPD) exacerbations. A preference-based algorithm for the EXACT would allow utilities to be reported from patients during an exacerbation when EQ-5D data are not available. Objective To develop the exacerbations of chronic obstructive pulmonary disease tool-utility (EXACT-U), a condition-specific preference-based measure to report utilities from the EXACT for use in cost-effectiveness studies. Methods Five items with three to five levels comprise the EXACT-U. Two groups of health states and respondents were constructed to allow for model development (Development group) and predictive validity testing (Validation group) using independent samples. Members of the UK general public each valued 11 randomized health states using time trade-offs (TTOs) scaled from full health/dead with 10-year durations. Regression models estimated from the Development group using individual data, mean data, and panel designs. Models assessed by number of inconsistent coefficients estimated and R 2 and tested against observed utilities from the Validation group using mean absolute error (MAE) and root mean squared error (RMSE). Results A total of 55 health states, including the best and worst states, were valued in TTO interviews conducted with 400 respondents. Ten models were developed. The final preferred model contained no logical inconsistencies and found MAE = 0.04 and RMSE = 0.05 with a predicted utility range from 0.09 to 0.95. Conclusions The EXACT-U is a condition-specific preference-based measure with strong predictive validity to report daily utilities during an exacerbation.

Estimating a Preference-Based Index for a 5-Dimensional Health State Classification for Asthma Derived from the Asthma Quality of Life Questionnaire

This article presents a valuation study to estimate a preference-based index for a 5-dimensional health state classification for asthma (AQL-5D) derived from the Asthma Quality of Life Questionnaire (AQLQ). A sample of 307 members of the UK general population valued 99 asthma health states selected from the AQL-5D using the time tradeoff technique. Models were estimated to predict all possible 3125 health states defined by the AQL-5D, and the models were compared in terms of their ability to predict mean values for the 99 states. Mean health state values ranged from 0.39 to 0.94 based on an average of 22 valuations per state. A main effects model estimated on mean health state values and adjusted for consistency had the best predictive ability (mean absolute error of 0.047 and only 9/98 states with errors >0.1) and the most logical consistency with levels of the AQL-5D. The low number of valuations per state may have resulted in unreliable estimates for the models. Preference-based condition specific measures are limited in their ability to make cross-disease comparisons. This is the first study to derive a condition-specific preference-based measure from an existing measure of health-related quality of life in asthma for use in economic evaluation.

The Use of Rasch Analysis in Reducing a Large Condition-Specific Instrument for Preference Valuation

The majority of health-related quality-of-life instruments are not preference-based measures and so cannot be used within cost utility analysis. The Asthma Quality of Life Questionnaire (AQLQ) is one such instrument. The aim of this study was to develop a health state classification that was amenable to valuation from the AQLQ, this being the 1st stage in developing a condition-specific preference-based measure for asthma patients. Rasch models were applied to samples of responders to the AQLQ with the aim of selecting a number of items for a preference-based utility measure (AQL-5D). Selection of items for the evaluation survey was supported with classical psychometric criteria for item selection (feasibility, internal consistency, floor and ceiling effects, and responsiveness). Rasch analysis proved to be a useful tool in assisting in the initial process of selecting items from an existing health-related quality-of-life instrument in the construction of the AQL-5D. The method is recommended for use alongside classical psychometric testing to aid in the development of preference-based measures.

Developing preference-based health measures: using Rasch analysis to generate health state values

Condition-specific measures may not always have independent items, yet existing techniques of developing health state utility values from these measures are inappropriate when items are not independent. This study develops methods for deriving and valuing health states for a condition-specific preference-based measure where items are not independent. The analysis has three stages: firstly, Rasch analysis is used to develop a health state classification system from the Flushing Symptoms Questionnaire (FSQ) that is amenable to valuation and to identify a set of health states for valuation. Secondly, a valuation survey of the health states using time-trade-off (TTO) methods is conducted to elicit health state values. Finally, regression models are applied to map the relationship between mean TTO values and Rasch logit values. The model is then used to estimate health state values for all possible health states. Rasch models were fitted to 1,270 responders to the FSQ and a series of 16 health states were identified for the valuation exercise. An ordinary least squares model best described the relationship between mean TTO values and Rasch logit values (R (2) = 0.958; root mean square error = 0.042). This study demonstrates how health state utility values can be mapped onto Rasch logit values in order to value all states defined by the FSQ, a condition-specific measure where items are not independent. This should significantly enhance research in this field.

Measuring and valuing mental health for use in economic evaluation

This article presents research undertaken as part of a wider programme of work concerned with measuring and health and wellbeing for economic evaluation. The focus is on developing quality adjusted life years (QALYs) in mental health, but the issues are common across all areas of health care. The article begins by reviewing the issues of what should be valued (health or broader notions of wellbeing), how mental health and wellbeing should be described, how mental health states should be valued and who should do the valuing. The article presents four pieces of work. The first is a re-analysis of the ONS Psychiatric Morbidity 2000 Survey to provide evidence on the relevance of generic measures across different mental health disorders. It found that common mental health problems, such as anxiety and depression, had a significant impact on the generic preference-based measure of health in the SF-6D, but psychosis and personality disorders did not. The article then presents two studies using the ratings of people experiencing the states of health. Both studies found that people experiencing different health states gave mental health greater weight than physical health compared to members of the general public trying to imagine the health states. Finally, the article presents a study developing a condition-specific preference-based measure for calculating QALYs from an existing measure of mental health, the CORE-OM, using modern psychometric methods to construct health states amenable to valuation. It also considers a proposal to develop an entirely new QALY measure in mental health.