ISSUE: Methods currently used to obtain the utilities used in calculating QALYs rest on a combination of value judgements eg. about whose preferences are relevant; and assumptions about the properties utilities should have. But the theoretical rationale for these specific requirements is not strong. Given the non-trivial problems that exist with those methods, is it time for a radical re-think? What would a new paradigm look like, and what alternative, practical solutions could HEOR provide to support and strengthen future use of QALYs?

OVERVIEW: Current practice in assessing utility in QALYs rests on a number of strong value judgements – and is fraught with unresolved issues (eg what methods to use? how to elicit values < 0? etc). There is understandable reluctance to depart from the current paradigm, least it undermines the use of QALYs. In this issues panel, we consider three radical ideas: Dropping ‘dead’ as an anchor; dropping the reliance on the general public; and dropping utility as the theoretical basis for methods. In each case, the panellists attempt to show how practical alternative approaches exist, that could support a new basis for 'quality adjusting' QALYs. This session aims to engage the audience in discussion and debate.