o B d & W 1 t n this second commentary on potential gender bias in commonly used economic evaluation methods uch as cost-effectiveness analysis (CEA) and cost– enefit analysis (CBA), we consider gender differences n health-related quality of life (QOL) and gender ifferences in health impacts on family well-being. he commentary focuses on cost–utility analysis CUA). In CUA, the outcome is quality-adjusted lifeears (QALYs) and the analytic approach is often a athematical model of a sequence of events called a ecision analytic model. QALYs account for time lived in ifferent health states that are valued using societal references, namely, health-related QOL measures hat are scored based on rankings or valuations obained from a general cross-section of society. Bias in CUA related to QOL may arise if there are ender differences in the experience of symptoms as easured by commonly used QOL instruments or here are gender-specific disease symptoms and conitions that are not measured accurately by available OL instruments. The U.S. Panel on Cost-Effectiveess in Health and Medicine (Gold, Siegel, Russell, & einstein, 1996) recommended that QALYs be calcuated with health utility weights representative of the ntire population. This practice may introduce bias if en and women have different behavioral reactions o (and different QOL interpretations of) certain health imensions. Although the panel allowed for the posibility of using health utility weights specific to the ubpopulation being studied, accepted methods for