The cost-effectiveness of health care interventions is often evaluated using quality-adjusted life years (QALYs) as a measure of outcome. There is a debate on whether QALYs should use patient preferences as opposed to community preferences. This article shows that patient preferences have a theoretical foundation in preference-utilitarian theory and welfare economics. In contrast, this study found no compelling theoretical basis for community preferences. There is a need for further development of a normative framework to inform the choice of preference source.
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