OBJECTIVE: The objective of this study is to assess the association between health state utilities, HRQOL and willingness to pay. METHODS: As part of a larger study a convenience sample of adult ambulatory asthma patients were recruited from community pharmacies in the state of Georgia, USA. Adult asthma patients identified to participate in the study were asked to complete a self-administered HRQOL survey. Patients were asked to complete generic (Short Form - SF-12, Health Utilities Index3 - HUI3, EuroQol Index - EQ5D, EuroQoL visual analogue scale - EQVAS) and disease specific (Juniper's mini-Asthma Quality of Life Questionnaire - AQLQ) HRQOL instruments. SF-12 was assessed using mental and physical summary scores (MCS and PCS, respectively). Willingness to pay (WTP) was assessed using the payment card approach for two scenarios: a hypothetical asthma cure and a treatment. RESULTS: Majority of respondents were female (70%), with an average age of 50.6 years and incomes < $40,000 (n = 70). Preference scores for HUI3, EQ5D and EQVAS were 0.62, 0.64, and 0.66 respectively. Average score for AQLQ was 4.46 and for norm based PCS, and MCS, 40.07 and 46.94, respectively. Patients reported to be WTP US$89 and US$62 per month for an asthma cure and treatment, respectively. Pearson r correlations between generic HRQOL instruments (HUI3, EQ5D and EQVAS) and AQLQ were moderate to high in the predicted direction (r = 0.434 to 0.689, p <0.01). PCS and MCS scores correlated moderately with preference based measures (r == 0.306 to 0.628, p <0.05). WTP for an asthma treatment was moderately correlated with AQLQ and its dimensions (p <0.05). CONCLUSION: Study findings show a preference based disease specific measure was a better predictor of WTP than a non preference based metric. This can be explained by additional sensitivity of a disease specific measure and the underlying utility framework purported to underlie WTP and utility measures.