Valuing Health States for Use in Cost-Effectiveness Analysis


This article reviews the general issues in valuing health states for use in cost-effectiveness analysis and the specific issues considered by the National Institute for Health and Clinical Excellence (NICE) in its recent review of the methods of technology appraisal. The general issues are how to describe health, how to value health and who should provide the values for health. The specific issues considered by NICE included whether and what should be the reference-case instrument, what to do when there are no data using the reference-case measure, what to do when the reference-case measure is not suitable and how to judge when it is not suitable, how to review and synthesize data, and how to incorporate health-state utility values into cost-effectiveness models.

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This paper was initially prepared as a briefing paper for NICE as part of the process of updating the Institute’s 2004 Guide to the Methods of Technology Appraisal. The work was funded by NICE through its Decision Support Unit (DSU), which is based at the universities of Sheffield, Leicester, York, Leeds and at the London School of Hygiene and Tropical Medicine.

The author has no conflicts of interest that are directly relevant to the content of this article.

The author thanks colleagues at ScHARR (Julie Ratcliffe, Aki Tsuchiya, Roberta Ara and Allan Wailloo), members of the NICE DSU (Mark Sculpher, Chris McCabe and Tony Ades) and Louise Longworth for comments on earlier drafts. Any remaining errors are the author’s responsibility.

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Correspondence to Professor John Brazier.

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Brazier, J. Valuing Health States for Use in Cost-Effectiveness Analysis. Pharmacoeconomics 26, 769–779 (2008).

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  • Reference Case
  • Valuation Method
  • Standard Gamble
  • Full Health
  • Technology Appraisal