A Systematic Review of Demand-Side Methods of Estimating the Societal Monetary Value of Health Gain

Abstract

Objectives: Although many reviews of the literature on cost-effectiveness thresholds (CETs) exist, the availability of new studies and the absence of a fully comprehensive analysis warrant a new review. This study systematically reviews demand-side methods for estimating the societal monetary value of health gain.Methods: Several electronic databases were searched from inception to October 2019. To be included, a study had to be an original article in any language, with a clearly described method for estimating the societal monetary values of health gain and with all estimated values reported. Estimates were converted to US dollars ($), using purchasing power parity (PPP) exchange rates and the gross domestic product (GDP) per capita (2019).Results: We included 53 studies; 45 used direct approach and 8 used indirect approach. Median estimates from the direct approach were PPP$ 24 942 (range 554-1 301 912) per quality-adjusted life-year (QALY), which were typically 0.53 (range 0.02-24.08) GDP per capita. Median estimates using the indirect approach were PPP$ 310 051 (range 36 402-7 574 870) per QALY, which accounted for 7.87 (range 0.68-116.95) GDP per capita.Conclusions: Our review found that the societal values of health gain or CETs were less than GDP per capita. The great variety in methods and estimates suggests that a more standardized and internationally agreed methodology for estimating CET is warranted. Multiple CETs may have a role when QALYs are not equally valued from a societal perspective (eg, QALYs accruing to people near death compared with equivalent QALYs to others).

Willingness to Pay for One Additional Quality Adjusted Life Year: A Population Based Survey from China

“…Since the indirect method leads to a very high WTP/Q due to the income constraint not being taken into account, we focus on the direct approach in this study. The design of this study is based on previous publications [8][9][10][11]17], including questionnaires for different types of QALY (quality-of-life improvement and life extension), different QALY sizes and different certainty (50%, 75% and 100%) of health outcome.…”

The Broader Opportunity Costs in the Broader Cost-Effectiveness Analysis Framework

“…These exercises are methodologically complex and some have pointed out the difficulties of arriving at a social aggregation function with a broad consensus and social legitimacy [8,29]. However, in the health economics literature, there is a vast body of empirical research aimed at eliciting the monetary value of health outcomes (see the recent review identifying 53 studies in [47]) and there is an even longer tradition in environmental economics, with published methodological standards for monetary valuations of environmental impacts [48]. Other routes that might be worth pursuing involve the use of the well-being valuation approach, as conducted by Himmler et al when estimating the monetary value of health and capability well-being [30], or the methods proposed by Phelps [49], who specified utility as a function of income using estimates of relative risk aversion.…”

Economic evaluation of psychological treatments for common mental disorders in low- and middle-income countries: a systematic review

“…representing supply-side constraints or demand-side thresholds reflecting societal WTP for health gains (Culyer, 2016;Vallejo-Torres et al, 2016;Thokala et al, 2018). A healthy body of work exists around valuing demand-side thresholds using societal or individual preference-based willingness to pay studies or value for statistical life conversions (Shiroiwa et al, 2010;Nimdet et al, 2015;Ryen and Svensson, 2015;Gloria et al, 2021). Demand-side thresholds may be more conceptually appropriate thresholds for appraising cost-effectiveness using societal ICERs.…”