Estimation of the cost-effective threshold of a quality-adjusted life year in China based on the value of statistical life

Abstract

Cost-effective threshold (CET) is essential for health technology assessment and decision-making based on health economic evaluations. Recently, it has been argued that the commonly used once and three times of gross domestic product (GDP) per capita CETs of a quality-adjusted life year (QALY) are not necessarily empirically supported in all countries. Therefore, we aimed to estimate the CET of a QALY as times of GDP per capita in China, of which the reimbursement coverage decisions are increasingly engaging economic evaluations. Estimates on the value of statistical life (VSL) in China were identified from several studies in the literature and converted to times of GDP per capita, the weighted average of which was used for subsequent calculation. By pooling data on population mortality, health utility, and age distribution, we estimated the value of a statistical QALY (VSQ) from VSL using an established mathematical process, which represented the theoretical upper bound of CET. The corresponding point estimate and theoretical lower bound were obtained using their numerical relationships with the upper bound. Scenarios analyses were also conducted. The estimated CET, its upper bound, and its lower bound were 1.45, 2.90, and 1.16 times of GDP per capita in China, respectively. In different scenarios, the estimated CET varied but was greater than once GDP per capita in most cases. As such, the CET of a QALY in China is close to 1.5 times of GDP per capita, which should be benchmarked for future ICER-based coverage decisions.

Cost-Effectiveness of Tislelizumab Versus Docetaxel for Previously Treated Advanced Non-Small-Cell Lung Cancer in China

“… Ochalek et al (2020 ) estimated that the CET in China was below one time GDP per capita using a marginal productivity approach. Another study based on the value of the statistical life (VSL) approach found that the CET per QALY in China is close to 1.5 times (ranging from 1.2 to 3.0) of GDP per capita ( Cai et al, 2021 ). Nevertheless, it was still proposed that a higher threshold should be afforded for serious diseases with a high mortality risk ( Cai et al, 2021 ; Lakdawalla and Phelps, 2021 ).…”

“…Another study based on the value of the statistical life (VSL) approach found that the CET per QALY in China is close to 1.5 times (ranging from 1.2 to 3.0) of GDP per capita ( Cai et al, 2021 ). Nevertheless, it was still proposed that a higher threshold should be afforded for serious diseases with a high mortality risk ( Cai et al, 2021 ; Lakdawalla and Phelps, 2021 ). Three times of GDP per capita is the widely used criterion to judge cost-effectiveness by scholars and policymakers in China, especially in the field of cancer treatment ( Liu et al, 2019 ; Liu et al, 2020 ; Gong et al, 2021 ; Shi et al, 2021 ).…”

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

“…Furthermore, a comparison of our results with those of a very comparable study would provide further evidence of the validity of this research. Cai et al [ 15 ] estimated the monetary value of a QALY based on the value of statistical life to be 1.5 times the GDP per capita in China, equivalent to almost RMB 100,000 (USD 14,952). Song and Lee [ 29 ] found that the average WTP/Q in South Korea was about RMB 145,000 (USD 21,642).…”

“…Therefore, this threshold could only be used to a limited extent for economic evaluations. Using the published literature, Cai et al [ 15 ] first estimated the value of statistical life and then calculated the cost-effective threshold to be 1.5 times the GDP per capita. Furthermore, Zhao et al [ 16 ] proved the feasibility of quantifying the monetary value per QALY with a WTP approach.…”

How to co-exist with COVID-19? A health economics explanation based on the Chinese experience

“…In health economics, health effectiveness can be measured by quality-adjusted life years (QALYs). QALY is defined as "a unit of life expectancy that is adjusted for the quality of life during those years" [12], and it serves as the basis for assessing the value of life [13]. An increase in QALYs translates into better health outcomes.…”