We introduce a new preference-based framework for conditional treatment effect estimation and policy learning, built on the Conditional Preference-based Treatment Effect (CPTE). CPTE requires only that outcomes be ranked under a preference rule, unlocking flexible modeling of heterogeneous effects with multivariate, ordinal, or preference-driven outcomes. This unifies applications such as conditional probability of necessity and sufficiency, conditional Win Ratio, and Generalized Pairwise Comparisons. Despite the intrinsic non-identifiability of comparison-based estimands, CPTE provides interpretable targets and delivers new identifiability conditions for previous unidentifiable estimands. We present estimation strategies via matching, quantile, and distributional regression, and further design efficient influence-function estimators to correct plug-in bias and maximize policy value. Synthetic and semi-synthetic experiments demonstrate clear performance gains and practical impact.