OBJECTIVE: To derive one European EQ-5D value set that can be used to calculate a European EQ-5D health-status index based on preferences of the general public. EQ-5D from the EuroQol Group is an instrument capable of summarizing health-related quality of life into a single index value by applying general population preference weights. Values have been derived for EQ-5D health states using the visual analogue scale (VAS) or time trade-off (TTO) approach. The option to derive European VAS- and TTO-based EQ-5D health status models has been investigated. METHODS: Multi-level analysis was performed on 82,910 observations of VAS values derived from 11 studies in different countries and on 50,780 TTO observations derived from three studies. RESULTS: After controlling for background variables, it was found that the country of origin of the study did not have a consistent effect on the VAS valuations of the EQ-5D health states. The evidence shows that European countries may share a similar value system for VAS ratings of health states. All coefficients have the right signs, while the values all differ from zero and produce values that are plausible. The explained variance by the model describing VAS values is 74.5 %. Multilevel analysis of the TTO valuations revealed that on average the German values are 20 % higher than the English and Spanish values. Half of this difference can be explained by controlling for background variables. CONCLUSIONS: These results suggest that while more work is required to establish a European TTO-based health-status index, a European VAS-based EQ-5D health-status index is viable. A European health-status index has two advantages: i) An index would not have to be generated separately for each European country, and ii) the index can be used in multi-national randomized clinical trials examining cost effectiveness of pharmaceutical product.