Three key factors determine quality of life utilities used in health technology assessment: the elicitation method, who is asked, and how data is modeled. However, there is no agreement on how to choose between options for these factors. Researcher choices significantly impact utilities but cannot be determined by statistics alone. Current methods also rely on stated preferences without a market to validate results. Ultimately, choices about utilities should be guided by health technology assessment bodies based on their specific contexts, not researchers, and sensitivity analyses around different utility estimates are preferable to single point values.