Short running title: Incorporating patient and public views in multi attribute utility instrumentsAbstract 2 Multi attribute utility instruments (MAUI) are being increasingly used to generate utility data which can be used to calculate quality adjusted life years (QALYs). This QALY data can then be incorporated into a cost utility analysis as part of an economic evaluation, to inform health care resource allocation decisions. Many health care decision making bodies around the world such as The National Institute for Health and Care Excellence require the use of generic MAUIs. Recently there has been a call for greater input of patients in the development of patient reported outcome measures and this is now actively encouraged. By incorporating the views of patients, greater validity of an instrument is expected and it is more likely that patients will be able to self-complete an instrument, which is the ideal when obtaining information about a patient's health related quality of life. This paper examines the stages of MAUI development and the scope for patient and/or public involvement at each stage. The paper then reviews how much the main generic MAUIs have incorporated the views of patients/the public into the development of their descriptive systems at each of these stages and the implications of this. The review finds that the majority of MAUIs had very little input from patients/the public. Instead, existing literature and/or the views of experts was used. If we wish to incorporate patient/public views in future development of MAUIs, then qualitative methods are recommended.
Key Points for Decision Makers The majority of multi attribute utility instruments had very little involvement of patients in the development of their descriptive systems The descriptive systems of multi attribute utility instruments were mostly developed using top down methods, which made use of existing literature and/or views of experts in determining what should be included If patient or public views are to be incorporated in the development of descriptive systems in the future, qualitative methods are recommended.3