Background <p>Coronavirus disease 2019 (COVID-19) is an acute respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe disease may require hospitalisation and respiratory support, which can cause longer-term morbidity. Patient utility data are limited, especially for severe disease where data collection can be challenging or unethical. A vignette study was designed to estimate utility values for COVID-19 disease states.</p> Methods <p>A sample of United Kingdom (UK)-based adults (<i>N</i> = 500) completed the EQ-5D-5&#xa0;L questionnaire for eight vignettes as patient proxies in September 2021. Vignettes qualitatively described hospitalisation and disease severity permutations, informed by a large UK-based COVID-19 infection survey. Recruitment was stratified to reflect UK demographics. EQ-5D utilities were derived using the appropriate UK value set.</p> Results <p>Recovery without long-term sequelae had the highest utility (mean [standard deviation]: 0.87 [0.14]), followed by pre-infection (0.73 [0.22]). The intensive care unit state had the lowest utility (–0.38 [0.14]). Mild and moderate outpatient states reported similar utility (0.29 [0.26] vs. 0.31 [0.27]). The severe general hospital ward state had lower utility than the high dependency unit state (–0.18 [0.24] vs. − 0.11 [0.25]). Recovery with long-term sequelae had low utility (0.21 [0.29]).</p> Conclusions <p>Mean utility values declined as COVID-19 disease state severity increased, suggesting that COVID-19 is likely to impact patient quality of life, in line with published literature. However, the evolving nature of COVID-19 may limit the generalisability of findings to the current disease landscape. Nevertheless, generation of utility values using a vignette-based approach represents a reasonable alternative where collection patient health-related quality of life data is infeasible, albeit with some limitations.</p> Trial registration <p>Not applicable.</p>