How does the perception of pain determine the selection between different treatments?

We test the QALY concept to evaluate the utility of therapies. The QALY is the sum of the duration of each health state a patient faces weighted by the utility the patient obtains from this state. The QALY implies linear utility functions over duration. Corresponding analyses for health-related decisions are problematic as inducing health levels is difficult. In this study, we evaluate both utilities over pain duration for a fixed pain level and over pain intensity for a fixed duration, with real health consequences, using the cold pressor test. We find that, for human decision-makers, utility over pain duration does not increase linearly over time when making health-related decisions. This suggests that the QALY might not capture preferences as intended.