Quality-adjusted life years (QALY) utility models under expected utility and rank dependent utility assumptions

Quality-adjusted life years (QALY) utility models are multiattribute utility models of survival duration and health quality. This paper formulates six classes of QALY utility models and axiomatizes these models under expected utility (EU) and rank-dependent utility (RDU) assumptions. The QALY models investigated in this paper include the standard linear QALY model, the power and exponential multiplicative models, and the general multiplicative model. Emphasis is placed on a preference assumption, the zero condition, that greatly simplifies the axiomatizations under EU and RDU assumptions. The RDU axiomatizations of QALY models are generally similar to their EU counterparts, but in some cases, they require modification because linearity in probability is no longer assumed, and rank dependence introduces asymmetries between the domains of better-than-death health states and worse-than-death health states. (C) 1999 Academic Press.