Willingness to Pay per Quality-Adjusted Life Year: Is One Threshold Enough for Decision-Making?

Fei-Li Zhao · Tian Wang · Jiuhong Wu · Shu‐Chuen Li

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Health Systems, Economic Evaluations, Quality of Life Economic and Environmental Valuation Delphi Technique in Research

Abstract

OBJECTIVE: To estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) ratio with the stated preference data and compare the results obtained between chronic prostatitis (CP) patients and general population (GP). METHODS: WTP per QALY was calculated with the subjects' own health-related utility and the WTP value. Two widely used preference-based health-related quality of life instruments, EuroQol (EQ-5D) and Short Form 6D (SF-6D), were used to elicit utility for participants' own health. The monthly WTP values for moving from participants' current health to a perfect health were elicited using closed-ended iterative bidding contingent valuation method. RESULTS: A total of 268 CP patients and 364 participants from GP completed the questionnaire. We obtained 4 WTP/QALY ratios ranging from $4700 to $7400, which is close to the lower bound of local gross domestic product per capita, a threshold proposed by World Health Organization. Nevertheless, these values were lower than other proposed thresholds and published empirical researches on diseases with mortality risk. Furthermore, the WTP/QALY ratios from the GP were significantly lower than those from the CP patients, and different determinants were associated with the within group variation identified by multiple linear regression. CONCLUSIONS: Preference elicitation methods are acceptable and feasible in the socio-cultural context of an Asian environment and the calculation of WTP/QALY ratio produced meaningful answers. The necessity of considering the QALY type or disease-specific QALY in estimating WTP/QALY ratio was highlighted and 1 to 3 times of gross domestic product/capita recommended by World Health Organization could potentially serve as a benchmark for threshold in this Asian context.

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References

1989Using surveys to value public goods: the contingent valuation method 1990Using Surveys to Value Public Goods: The Contingent Valuation Method 2003The contingent valuation method: a review 1991Using Surveys to Value Public Goods: The Contingent Valuation Method.2004Use of Cost-Effectiveness Analysis in Health-Care Resource Allocation Decision-Making: How Are Cost-Effectiveness Thresholds Expected to Emerge?2009International survey on willingness‐to‐pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?1982Health-related quality of life measurement for evaluation research and policy analysis.2005Willingness to Pay for a Quality-Adjusted Life Year: Implications for Societal Health Care Resource Allocation

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2014Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences 2021Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression

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