The numbers of quality-adjusted life years (QALYs) gained are increasingly being used to represent the gains in individual utility from treatment. This requires that the value of a health improvement to an individual is a simple product of gains in quality of life and length of life. The paper reports on a systematic review of the literature on two issues: whether the value of a state is affected by how long the state lasts; and by states that come before or after it. It was found that individual preferences over health are influenced by the duration of health states and their sequence. However, whilst there is much variation across individual respondents, the assumptions tend to hold much better when valuations are aggregated across respondents, which is encouraging for economic evaluations that rely on using average (mean or median) values
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