The valuation of health benefit is arguably the most fundamental issue underpinning all clinical and economic evaluation. However, there is disagreement about the choice of method by which such valuation is established. Advice issued by HTA agencies generally favours utility elicitation methods but there is growing support for simpler methods that evoke ordinal judgements. Decision-makers face difficult choices when reviewing evidence based on different valuation methods. OBJECTIVES: To examine the extent to which ordinal preferences captured through VAS ratings are preserved by TTO utility elicitation methods. METHODS: The UK MVH study (n=3,395) provides the empirical basis for the EQ-5D values required in economic evaluations submitted to NICE. This study collected both VAS ratings and TTO utilities for 13 EQ-5D health states per respondent. These data have been re-analysed for the purposes of this paper. RESULTS: Spearman's Rank Correlation Coefficient (rho) for TTO and VAS valuations was computed on a within-subject basis for all respondents, yielding a mean of 0.771. 45% of respondents had a Spearman's rho of less than 0.80 (equivalent to a mean absolute difference of 1.7 in ranking over all 13 states). Over 85% of respondent's TTO values differed in rank by more than 3/13 places when compared with VAS ratings. Respondent characteristics did not account for differences in rankings of TTO and VAS scores. CONCLUSIONS: This study shows that for almost half the MVH respondents, TTO utilities did not coincide with ordinal preferences as revealed by their VAS scores. These results challenge a number of basic assumptions - about the transformation of ordinal values into cardinal utilities; the superiority of TTO over VAS methods and the extent to which TTO “accurately” represents individual preferences at all. Ultimately they undermine the status of TTO as a legitimate measure of preferences in social decision-making.