Can multi-attribute utility instruments adequately account for subjective well-being?

The quality of life is included in cost utility analyses by weighting the relevant years of life by health state utilities. However, the utilities predicted by multi-attribute utility instruments (MAUIs) for this purpose do not correlate highly with the subjective well-being (SWB) of people experiencing the health states. This suggests that MAUIs may not take account of the SWB experienced by patients. This article explores an alternative hypothesis: that a failure of an MAUI to account for variation in SWB is primarily a result of the failure of its descriptive system to include the elements of health that determine SWB and that cannot therefore be included in assessment of the health state utility. Methods: Survey data are used to determine the extent to which 6 MAUIs with significantly different descriptive systems explain differences between the SWB of the healthy public and patients in 7 disease areas. Results: The EQ-5D-5L takes least account and AQoL-8D most account of SWB. AQoL-8D overpredicts the loss of SWB in 2 cases where hedonic adaptation is known to occur. Discussion: Results suggest that, to a large extent, utility can account for variation in SWB. The case for replacing utility with SWB in economic evaluation studies has arisen, in part, because elements of importance for SWB have been omitted from the descriptive systems of commonly used MAUIs.