A Systematic Review of Studies Eliciting Willingness-to-Pay per Quality-Adjusted Life Year: Does It Justify CE Threshold?

Nimdet, Khachapon; Chaiyakunapruk, Nathorn; Vichansavakul, Kittaya; Ngorsuraches, Surachat

doi:10.1371/journal.pone.0122760

Cited by 97 publications

(79 citation statements)

References 51 publications

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“…According to the Grossman model of health economics [23], investment in healthcare systems faces decreasing marginal return to scale. In line with this model, countries with higher GDPs often have more funds available to invest in healthcare systems and may have a populace more interested in experiencing a higher level of health [23].…”

Section: Introductionmentioning

confidence: 99%

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On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review

Cameron

Ubels

Norström

2018

Global Health Action

231

186

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Background: The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system. Objectives: The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data. Methods: A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations. Results: Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made. Conclusions: Most national C/E thresholds identified in our review fall within the WHO’s recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they base their decision-making process on erroneous presumptions or non-evidence-based methodologies. The commonly referred to value of 100,000$ USD per QALY may potentially have some basis.

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Section: Introductionmentioning

confidence: 99%

“…In line with this model, countries with higher GDPs often have more funds available to invest in healthcare systems and may have a populace more interested in experiencing a higher level of health [23]. This results in rich countries being at particular risk of overinvesting in new, expensive medical interventions.…”

Section: Introductionmentioning

confidence: 99%

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review

Cameron

Ubels

Norström

2018

Global Health Action

231

186

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“…A recent meta-analysis also reported the thresholds of QALY gained by WTP method ranged from $2019 to $282,821, an astounding 140 fold difference. Due to variable methodologies and questionable contexts of QALY/DALY derivation with potentially flawed assumptions, economists are still in dissention as to the validity and future of QALY/DALY [49,50].…”

Section: Cost-utility Analysis (Cua)mentioning

confidence: 99%

Health Economic Evaluation: A Primer for Healthcare Professionals

Leung¹

2016

Primary Health Care

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Fundamental Concepts Costs, benefits, supply and demandIn any non-utopic society, resources (or goods) are finite (hence scarce) and they are constantly distributed to individuals to satisfy their needs (wants and preferences). Resources have to be produced (by sellers) to replenish consumption by individuals(consumers), who willingly let go of other resources (money) to accrue the resource(s) of their preference (consumer choice). Such transaction (bought and sold) between a consumer and seller is a re-allocation of resources (supplier's good versus consumer's money) at a mutually agreed price, where consumers' willingness to pay meets sellers 'willingness to accept. Here, consumers enjoy a benefit from the good/service by paying sellers the costs of the goods. In any market free from monopoly or regulation, this transaction price indicates equilibrium between supply and demand ( Figure 1).However, when more than one individual consume the same set of resources, competition will arise: as the net resources decrease the equilibrium price will shift, so that only the individual(s) who can now pay a higher price will continue to consume the decreasing resources. On the contrary, when resources become more available than needed, an excess will be left around and hence the demand falls and pulls down the equilibrium price. John Locke, an English philosopher and physician, first described this inverse supply-demand relationship in his writings in 1691, but the actual term "supply and demand" was not coined until 1767 by Denham-Steuart and Adam Smith, in his famous work of "the Wealth of Nations" [1,2]. By definition, supply and demand for any resource or commodity are susceptible to external constraints like weather (under-or over-production) and disasters that will compromise human viability (under-demand of luxurious items and over-demand of basic commodities) (Figure 2). Scenarios when supply and demand curves shift. For a commodity X in a society, there exists an equilibrium where supply curve S1 intersects demand curve D1, at the agreedutility(price) of U3 for a Q4 quantity of X. An epidemic came killing 15% of population and sent the economy to recession, shifting the demand curve for X to the left to D2 (now less people in total and less money earned). If the supply remained the same S1, it will be relatively in excess and hence the agreed utility (price) will fall to U4 for a lesser quantity of X (Q3). Now, if the production of X also fell, the supply curve will be shifted up to S2(harder to produce the same unit of good/service), leading to a higher agreed utility/price of U2 for a much less quantity of X.(Q1). AbstractIn its broadest term, economic evaluation (EE) is a comparative analysis of the input (costs) and the output (consequences, outcomes) of two or more alternatives to see if they are economically beneficial or feasible. The earliest form of economic evaluation took place in mid-19th century and since then; three main forms of EE have evolved which are employed in various settings: cost-benefit ...

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“…Nowadays, more countries in Asia have recently begun to adopt economic evaluation-based reimbursement policy [1][2][3]. The relatively new of universal health coverage in Indonesia [4] has highlighted the need to undertake economic evaluations, especially costutility analysis (CUA).…”

Section: Introductionmentioning

confidence: 99%

“…However, there is a clear need for a ceiling threshold, and more importantly, the threshold should be introduced on the basis of empirical evidence on societal values. Many studies have been made to estimate the WTP value as a ceiling threshold [2].…”

Section: Introductionmentioning

confidence: 99%

Reliability and Validity of Hypothetical Scenarios for Estimating Willingness to Pay (Wtp) Per Quality Adjusted Life Year (Qaly) in Indonesia Setting

Kristina

Endarti

Andayani

et al. 2017

Int J Pharm Pharm Sci

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Objective: To estimate validity and reliability of WTP questionnaire which WTP value can be taken as an indication of the monetary value of health gains, which may carry information regarding the appropriate height of the cost-effectiveness threshold.Methods: Three hundred respondents, in Yogyakarta province, Indonesia, were interviewed during June 2017. We examine a value of WTP associated with the following scenarios: 1) improving moderate condition; 2) extending life during terminal illness, and 3) lifesaving. The interview ascertained maximum hypothetical WTP for one QALY using a dichotomous bidding format with an open-ended final question, along with questions about the socio-economic factors. Concerning validity, the WTP of the 3 versions of hypothetical scenarios were compared as known-group validity and analysis of the sensitivity and specificity was performed. Test-retest reliability and alpha Cronbach were employed to measure internal consistency.Results: Analysis generally confirmed the validity and reliability of the WTP hypothetical scenarios. In terms of known group validity, there was significant difference across two scenarios (treatment v. s lifesaving), but no significant difference between mean WTP for treatment and terminal illness was found. Mean WTP for terminal illness (38 Million IDR) and lifesaving scenario (16 Million IDR) was significantly higher than that of treatment scenario (14 Million IDR). The WTP instrument showed good convergent validity (r=0.784), when comparing correlation between WTP value and utility score. Estimation of scenario's sensitivity and specificity in deriving expected WTP were 70.33 % and 38.98 %, respectively. The positive and negative predictive values were 64 % and 46 %. The test-retest reliability of WTP values indices excellent stability and reliability of the instrument with Spearman's rank correlation coefficient of 0.816 (p<0.001) Conclusion:This study demonstrated that the WTP instrument is feasible and relatively reliable for measuring the WTP values in Indonesia. For wider application of the instrument, its validity should be investigated further. Meanwhile, adoption of WTP as an empirical evidence of societal values is encouraged.

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A Systematic Review of Studies Eliciting Willingness-to-Pay per Quality-Adjusted Life Year: Does It Justify CE Threshold?

Cited by 97 publications

References 51 publications

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review

Health Economic Evaluation: A Primer for Healthcare Professionals

Reliability and Validity of Hypothetical Scenarios for Estimating Willingness to Pay (Wtp) Per Quality Adjusted Life Year (Qaly) in Indonesia Setting

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