HEALTH ECONOMICS Health Econ. 11: 679–693 (2002) Published online in Wiley InterScience (www.interscience.wiley.com). DOI:10.1002/hec.695 COST-EFFECTIVENESS ANALYSIS QALY-maximisation and public preferences: results from a general population survey Stirling Bryan a, *, Tracy Roberts a , Chris Heginbotham b and Alison McCallum c a Health Economics Facility, University of Birmingham, UK b East & North Hertfordshire Health Authority, UK c Department of Primary Care & Population Sciences, Royal Free & University College London Medical School, UK Summary The appropriate criteria that should be used in setting priorities in a publicly funded health care system remain open to debate. From a health economics perspective, quality-adjusted life years (QALYs) are increasingly portrayed as a measure of societal value and the criterion of QALY maximisation is then advocated. This paper reports a study that investigated the extent to which some of the assumptions underlying the QALY maximisation approach, notably constant marginal societal value for increases in the size of health programmes, the level of risk, and the level of benefit are supported by members of the public. A general population interview-based survey was conducted. The survey design employed conjoint methods. In general, the public preference data from this study, in themselves, are not much at odds with the core proportionality assumptions concerning societal value in the QALY maximisation model assumptions. The data are, however, at odds with reports from various previous studies. Copyright # 2002 John Wiley & Sons, Ltd. Keywords QALY-maximisation; public preference survey Introduction In order to ensure that health care resources are used in the most appropriate manner, to achieve maximum patient benefit, health care decision- makers need to adopt robust processes for setting priorities. Recent developments in the UK, such as the launch of the National Institute for Clinical Excellence (NICE), have encouraged a more open debate about the principles and issues concerned in health care resource allocation decisions [1–3]. However, the appropriate criteria that should be used in setting priorities in a publicly funded health care system are far from clear. From a health economics perspective, one criterion that might be considered as part of the decision-making process when setting health care priorities is the maximisation of quality-adjusted life years (QALYs). The objective of the study reported here was to investigate the extent to which a key assumption underlying the QALY-maximisation approach, is supported by members of the public, through an empirical investigation of public preferences in the context of health care resource allocation decisions. QALY-maximisation The QALY combines two forms of outcome of health care interventions, namely health-related Copyright # 2002 John Wiley & Sons, Ltd. Received 11 July 2000 Accepted 8 August 2001 *Correspondence to: Health Economics Facility, HSMC, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK; e-mail: s.bryan@bham.ac.uk