Estimation of the value of curative therapies in oncology: a willingness-to-pay study in China

Abstract

The objective of this study was to estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) among people with malignancies in China. The WTP for a QALY was estimated using a contingent valuation survey. Health utility was measured in EuroQol-5 dimensions (EQ-5D). The questionnaires were completed in face-to-face interviews. Respondents consisted of patients with malignant tumors and their family members and came from three tertiary hospitals in different cities with high, medium, and low gross domestic product (GDP) levels. In this study, we offered lump-sum payments and 10 year installment plans to respondents. Finally, we conducted sensitivity analysis and stepwise regression analyses to identify factors that affected the WTP/QALY ratios. A total of 1264 people participated in this survey, and 1013 people gave WTP responses for further analysis. The mean and median WTP/QALY values based on the lump-sum payments were 366,879 RMB (53,171USD, 5.1 times the GDP per capita) and 99,906 RMB (14,479USD, 1.39 times the GDP per capita) for the overall sample; 339,330 RMB (49,178USD, 4.71 times the GDP per capita) and 83,875 RMB (12,156USD, 1.16 times the GDP per capita) for the patient group; and 407,396 RMB (59,043USD, 5.66 times the GDP per capita) and 149,436 RMB (21,657USD, 2.08 times the GDP per capita) for the family group. Considering the skewedness of the data distribution, we suggest setting the cost-utility threshold with reference to the median. When the payment plan changed to 10-year installments, the median increased to 134,734RMB (19,527USD), 112,390 RMB (16,288USD) and 173,838 RMB (25,194USD) for the above groups, respectively. EQ-5D-5L health utility, annual household income per capita, patients with other chronic diseases, occupation, regular physical examinations (patients) and age (family members) were significantly related to WTP/QALY. This study provides empirical evidence of the monetary value of a QALY from a sample of the Chinese population with malignancies. In addition, the ratio of the WTP/QALY to GDP per capita was related to the disease and hypothetical scenario, and a higher ratio of GDP per capita for malignant tumor therapies should be considered.

Estimating the cost-effectiveness threshold of advanced non-small cell lung cancer in China using mean opportunity cost and contingent valuation method

“…Comparing with the aforementioned countries, China operates on a patient and medical insurance co-payment system, where patients bear a relatively significant heavy disease and economic burden, resulting in a lower WTP [ 32 ]. Our patient WTP aligns with the median patient WTP of a previous study among Chinese cancer patients [ 17 ], confirming the negative attitude to WTP. Meanwhile, given humanitarian, sustaining industry interests and the upward adjustment of cancer threshold by many national healthcare systems, payer provide higher threshold for cancer can be explained when feasible within the financial capacity.…”

“…Given the significant degree of data dispersion, it is deemed that the median value better represents patient WTP. Analogous to payer, mean Patient WTP in our study was slightly higher than that of the Chinese general population (1.2 times per capita GDP) [ 40 ], Chinese chronic patients ($4700–7400 and $8799–9446, 0.8–1.3 and 1.1–1.2 per capita GDP) [ 12 , 42 ] and similar to prior Chinese cancer survey (1.39 per capita GDP) [ 17 ].…”

Tislelizumab versus sorafenib as first-line treatment for advanced hepatocellular carcinoma in China: a cost-effectiveness analysis

“…This finding indicates that the use of tislelizumab as a first-line treatment modality for advanced HCC has the potential to be considered cost-effective. Even in the current situation where some researchers and scholars are proposing to set the WTP at 1.5 times GDP ( 33 ), our present study is suggesting that the treatment of tislelizumab for advanced HCC is cost-effective in China.…”