Best-worst scaling (BWS) is an extension of the method of paired comparison to multiple choices that asks participants to choose both the most and the least attractive options or features from a set of choices. It is an increasingly popular way for academics and practitioners in social science, business, and other disciplines to study and model choice. This book provides an authoritative and systematic treatment of best-worst scaling, introducing readers to the theory and methods for three broad classes of applications. It uses a variety of case studies to illustrate simple but reliable ways to design, implement, apply, and analyze choice data in specific contexts, and showcases the wide range of potential applications across many different disciplines. Best-worst scaling avoids many rating scale problems and will appeal to those wanting to measure subjective quantities with known measurement properties that can be easily interpreted and applied.

Background: Researchers are increasingly investigating the potential for ordinal tasks such as ranking and discrete choice experiments to estimate QALY health state values. However, the assumptions of random utility theory, which underpin the statistical models used to provide these estimates, have received insufficient attention. In particular, the assumptions made about the decisions between living states and the death state are not satisfied, at least for some people. Estimated values are likely to be incorrectly anchored with respect to death (zero) in such circumstances.Methods: Data from the Investigating Choice Experiments for the preferences of older people CAPability instrument (ICECAP) valuation exercise were analysed. The values (previously anchored to the worst possible state) were rescaled using an ordinal model proposed previously to estimate QALY-like values. Bootstrapping was conducted to vary artificially the proportion of people who conformed to the conventional random utility model underpinning the analyses.Results: Only 26% of respondents conformed unequivocally to the assumptions of conventional random utility theory. At least 14% of respondents unequivocally violated the assumptions. Varying the relative proportions of conforming respondents in sensitivity analyses led to large changes in the estimated QALY values, particularly for lower-valued states. As a result these values could be either positive (considered to be better than death) or negative (considered to be worse than death).Conclusion: Use of a statistical model such as conditional (multinomial) regression to anchor quality of life values from ordinal data to death is inappropriate in the presence of respondents who do not conform to the assumptions of conventional random utility theory. This is clearest when estimating values for that group of respondents observed in valuation samples who refuse to consider any living state to be worse than death: in such circumstances the model cannot be estimated. Only a valuation task requiring respondents to make choices in which both length and quality of life vary can produce estimates that properly reflect the preferences of all respondents.