OBJECTIVES: Researchers and decision-makers use health gain measures to assess the value of health interventions. Our current understanding of how understandable and accessible these measures are to the community is limited, however. The goal of this study was to understand a diverse group of stakeholders’ attitudes and preferences for commonly used health gain measures.

METHODS: We recruited 20 stakeholders from the Boston area, including patients, caregivers, citizens, clinicians, and pharmacy/allied health professionals. We conducted two in-person focus groups, where participants learned, discussed, deliberated on, and ranked nine health gain measures.

We first conducted deliberations and ranking exercises separately within two groups: 1) patients and caregivers, and 2) citizens, clinicians, and health professionals, and then together as a large group. We recorded the deliberations and conducted a qualitative analysis that structured discussions into broad themes.

RESULTS: In deliberations, groups emphasized the importance of using patient values in population-based health gain measures, examining complementary measures together, and choosing measures that are intuitive and easy to understand. Patients and caregivers ranked the quality-adjusted life year (QALY) as the top choice. Other stakeholders favored multi-criteria decision analysis (MCDA). The final ranking conducted after unified deliberation showed the QALY as the top-ranked measure, followed by the clinical effectiveness rating method used by the U.S. Preventive Services Task Force, and MCDA.

CONCLUSIONS: Consistent with recommendations from the Second US Panel on Cost-effectiveness in Health and Medicine, the QALY is the most preferred health gain measure in our multi-stakeholder deliberation. However, stakeholders felt that other measures provided important complementary information that should be presented alongside the QALY, particularly since patient preferences were an important foundation. Future policymaking should consider incorporating the QALY, clinical effectiveness ratings, and MCDA into prioritization decisions