OBJECTIVES: National Institute for Health and Care Excellence (NICE) considers the quality-adjusted life year (QALY) to be the most appropriate generic measure of health benefit that reflects both mortality and health-related quality of life effects. The QALY is the sum of a person’s length of life in each health state multiplied by a quality-adjustment weight (that is, utility value) associated with that health state. Cost-effectiveness results are often sensitive to the choice of utility value, but relevant and comparable utility values are not always available leading to debate about the most appropriate utility values to include. The objective of the research was to review the health-related utility values used in economic models across NICE technology appraisal guidance for 4 metastatic cancers. METHODS: A cross-sectional review of manufacturer submissions and reports produced by independent academic groups was carried out to identify the health-related utility values used. Information relating to the methods used to elicit utility values that were selected for use in cost-effectiveness analyses were compared with methods specified by NICE as the reference case in its 2004 and 2008 Methods Guides. The review focused on guidance published before June 2013 for medicines treating metastatic breast cancer, metastatic colorectal cancer, metastatic hormone-refractory prostate cancer and metastatic non-small-cell lung cancer. Nineteen technology appraisals published between March 2002 and August 2012 met the inclusion criteria. RESULTS: Common themes or variations that exist between utility values selected by manufacturers and independent academic groups for each metastatic cancer and between the 4 metastatic cancers were analysed. The research also explored the methodological issues that were considered by the Appraisal Committee relating to the selection of utility values. CONCLUSIONS: Therefore, this research provides insight to the methodological considerations regarding incorporation of utility values that have informed health technology assessment decision-making in England for 4 metastatic cancers.