LAUSR

Editor We are grateful for the comments regarding our recent paper, highlighting a number of potential issues. We fully accept the limitations of the sample that responded to the telephone interview, which, as we discussed in the paper, was not a representative sample of the UK population. However, it is not necessarily correct that the population should have been representative of those at greatest risk of developing an aneurysm, as usual National Institute for Health and Care Excellence methodology requires that preferences for health and health care are derived from a general population sample, rather than a sample specific to the condition under consideration1. We also acknowledge the limitation of constraining the values of those who preferred open repair, a decision that was made to limit the cognitive burden of what was a demanding questionnaire. As regards the description of health states, these were prepared based upon systematic reviews2, qualitative interviews with patients, and a clinical consensus group3. They were intended to allow valuation of the processes of care independently of the long-term health outcomes, in such a way that they might be incorporated explicitly into cost-effectiveness analyses. Thus, omission of reintervention, quality of life and long-term outcomes was deliberate, as these are already accounted for in the calculation of quality-adjusted survival. Finally, the purpose of the paper was not to challenge any existing guidance, but to suggest that there may be societal preferences for aspects of the process of care that are distinct from outcomes, as measured in quality-adjusted life years. By identifying and quantifying such ‘process utilities’, it may be possible