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Health Econ Policy Law. 2008 Jan;3(Pt 1):85-91. doi: 10.1017/S1744133107004367.

Are subjective well-being measures any better than decision utility measures?

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VA Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, USA.


There are a number of substantial problems with using decision-based utility measures such as the time trade off and standard gamble to value improvements in health. Dolan (this issue) argues that because of these problems, it would be better to use measures of real experiences (subjective well being). We review evidence that supports criticisms of decision-based utility measures, whether provided by patients or non-patients. But we also review a number of substantial problems with currently used measures of subjective well-being, and point out that there is no definitive evidence that they represent any improvement over decision utility measures. We conclude with a call for expanded research into developing new tools for quantifying health-related quality of life that are more valid, more sensitive to changes in health status, and less biased.

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