Background and objectiveContingent valuation is widely used to determine individuals’ willingness to pay (WTP) for a health gain. Our study aimed to elicit an empirical estimate of the monetary value of a quality-adjusted life year (QALY) in a Greek outpatient setting in times of economic austerity and assess the impact of patients’ characteristics on their valuations.MethodsWe used a questionnaire as a survey tool to determine the maximum WTP for a health gain of a hypothetical therapy and to evaluate patients’ health-related quality of life (EuroQoL-5D-3L) and demographic and socioeconomic characteristics. EuroQoL tariffs were used to estimate health utilities. Mean WTP values were computed and ordinary least squares regressions performed on transformed Box-Cox and logarithmic dependent WTP per QALY variables to remedy observed skewness problems.ResultsAnalyses were performed for 167 patients with utility values less than unity. Mean WTP per QALY reported was similar for both payment vehicles examined: payments made out-of-pocket (€2629) and payments made through new tax imposition (€2407). Regression results showed that higher net monthly family income was associated with higher WTP per QALY for both payment vehicles. Moreover, the presence of a chronic condition and higher level of education were associated with higher out-of-pocket WTP per QALY and WTP per QALY through taxes, respectively.ConclusionThe very low WTP per QALY estimates could be explained by the recent severe economic depression and austerity in Greece. In fact, family income was found to be a significant predictor of WTP per QALY. Since these estimates deviate significantly from the cost-effectiveness thresholds still employed in economic evaluations in this country, research should be undertaken promptly to further examine this important issue using a nationwide representative sample of the general population along with WTP and other methodologies.Electronic supplementary materialThe online version of this article (doi:10.1007/s41669-017-0033-4) contains supplementary material, which is available to authorized users.

Objectives: To elicit a willingness-to-pay (WTP) per quality-adjusted life-year (QALY) estimate for the general Greek population and assess the impact of individuals' socio-demographic characteristics and motives on this estimate.Methods: A telephone-based survey was carried out employing a representative sample of the general Greek population (n = 1342). A computer-assisted telephone-interview method was adopted to ensure random sampling. A total of 528 participants reported a WTP value for a utility improvement from their current health to perfect health. Those individuals' motives were assessed through predefined statements. Test-retest reliability was assessed using intraclass correlation coefficient (ICC). Multiple linear regression (MLR) and one-way analysis of variance (ANOVA) tests were conducted to assess the effect of socioeconomic/demographic determinants and motive statements, respectively, on WTP/QALY. MLR was re-estimated considering as dependent variable the WTP/QALY estimate calculated for participants: (1) stating a WTP value # their household income and (2) presenting higher certainty regarding stated WTP value (sensitivity analysis).Results: Analysis revealed good reliability for WTP/QALY estimates and motive statements (ICC values . 0.8). Mean WTP/ QALY was V26 280. The respective 5% trimmed value was V14 862. Being a student and household income affected WTP/ QALY. Sensitivity analysis did not produce markedly different WTP/QALY predictors, implying the robustness of results, irrespective of the participant group considered. Individuals who indicated the inability to cover basic family needs or pay tax claims as motives reported lower WTP/QALY values compared with those not viewing these aspects as motives.Conclusions: Findings confirm that the World Health Organization's criterion used currently in Greek cost-effectiveness studies is not unreasonable. Additional research is essential to further explore WTP/QALY estimates in the Greek setting and facilitate informed decision making.

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Study aim was to elicit the Greek general population’s willingness-to-pay (WTP) for a health improvement (recovery to perfect health), examine attitudinal differences between willing- and unwilling-to-pay individuals regarding healthcare services provision, and investigate —using a logistic regression model—demographic/socioeconomic factors impact on their intention to pay for a health improvement. A research tool was developed to conduct a cross-sectional stated-preference telephone-based survey (January-February 2019) and a representative sample (n = 1342) of the Greek general population was queried. The computer-assisted telephone-interview (CATI) method was used to ensure random sampling. WTP was elicited using the iterative bidding technique. Participants’ attitudes toward healthcare services provision were assessed through pre-defined statements. Test-retest reliability of these statements was assessed using intraclass correlation coefficients (ICC). Logistic regression was employed to identify sociodemographic factors’ effect on WTP intention. Differences among individuals’ attitudes were assessed using the chi-square test. All analyses were conducted using the IBM SPSS Software v.25.0. Analysis showed acceptable reliability for WTP estimates (ICC = .67) and good reliability for healthcare services assessment statements (ICC = .83-.94). Mean WTP was estimated at €439.8. Respondents with higher educational level and higher household income were more likely to be willing to pay for a health improvement. On the contrary, older participants were less likely to be willing to pay. Most participants who considered public healthcare services to be of high quality were unwilling to pay. Logistic regression analysis led to the development of an effective predictive model regarding factors affecting individuals’ WTP intention for a health improvement. Further classification of unwilling-to-pay individuals into protest responders and “true” zero valuators showed that protest responders are unlikely to be representative of the population. Hence, study results can be used for debiasing WTP responses, leading to a more accurate use of WTP estimates by policy makers, exploiting WTP values in medical interventions cost-benefit analysis within reimbursement decisions framework.

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