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Fasseeh AN, Korra N, Elezbawy B, Sedrak AS, Gamal M, Eldessouki R, Eldebeiky M, George M, Seyam A, Abourawash A, Khalifa AY, Shaheen M, Abaza S, Kaló Z. Framework for developing cost-effectiveness analysis threshold: the case of Egypt. J Egypt Public Health Assoc 2024; 99:12. [PMID: 38825614 PMCID: PMC11144683 DOI: 10.1186/s42506-024-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.
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Affiliation(s)
- Ahmad N Fasseeh
- Faculty of Pharmacy Alexandria University, Alexandria, Egypt
- Syreon Middle East, Alexandria, Egypt
| | | | | | - Amal S Sedrak
- Department of Public Health, Cairo University, Cairo, Egypt
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Mary Gamal
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Randa Eldessouki
- Department of Community Health, Fayoum University, Fayoum, Egypt
| | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | | | - Ahmed Y Khalifa
- World Health Organization Representative Office, Cairo, Egypt
| | | | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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Berdud M, Ferraro J, Towse A. A theory on ICER pricing and optimal levels of cost-effectiveness thresholds: a bargaining approach. FRONTIERS IN HEALTH SERVICES 2023; 3:1055471. [PMID: 37693236 PMCID: PMC10484610 DOI: 10.3389/frhs.2023.1055471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 07/28/2023] [Indexed: 09/12/2023]
Abstract
In many health systems around the world, decisions about the reimbursement of-and patient access to-new medicines are based on health technology assessments (HTA) which, in some countries, include the calculation of an incremental cost-effectiveness ratio (ICER). Decision-makers compare the ICER against a pre-specified value for money criterion, known as the cost-effectiveness threshold (CET), to decide in favour of or against reimbursement. We developed a general model of pharmaceutical markets to analyse the relationship between the CET value and the distribution of the health and economic value of new medicines between consumers (payers) and producers (life science industry developers). We added to the existing literature in three ways: including research and development (R&D) cost for developers as a sunk cost; incorporating bargaining using the Nash bargaining solution to model payer bargaining power from regulation and use of competition; and analysing the impact of a non-uniform distribution of developers R&D costs on the supply of innovation. In some circumstances of bargaining power distribution and R&D cost, we found that using a CET value in HTA decision-making higher than the supply-side CET is socially efficient. Decision-makers should consider adjustable levels of the CET or interpretation of ICERs higher than the CET according to the bargaining power effect. The findings of this research pointed to the need for more research on the impact of bargaining power, how R&D investment responds to rewards, i.e. the elasticity of innovation, and pre- and post-patent expiry modelling.
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Affiliation(s)
- Mikel Berdud
- Office of Health Economics (OHE), London, United Kingdom
| | - Jimena Ferraro
- Economics Department, University of Buenos Aires, Buenos Aires, Argentina
- Interdisciplinary Institute of Political Economy, CONICET-University of Buenos Aires, Buenos Aires, Argentina
| | - Adrian Towse
- Office of Health Economics (OHE), London, United Kingdom
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Ye Z, Abduhilil R, Huang J, Sun L. Willingness to Pay for One Additional Quality Adjusted Life Year: A Population Based Survey from China. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:893-904. [PMID: 35934772 PMCID: PMC9358064 DOI: 10.1007/s40258-022-00750-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the population's willingness to pay (WTP) for an additional quality-adjusted life-year (QALY) in China. METHODS The WTP for an additional QALY (WTP/Q) was estimated using a contingent valuation survey with quota sampling and snowball sampling, using a pre-designed questionnaire with 18 hypothetical scenarios. The change in health state was depicted by the EQ-5D-5L. The questionnaires were completed by telephone and face-to-face interviews. Two-part regression models were used to test validity and how different factors affect WTP/Q. RESULTS A total of 2008 people participated in this survey and provided 3265 WTP responses for further analysis. The average WTP/Q for the entire sample is 113,120 Renminbi (RMB) (USD 16,884), which is 1.75 times the gross domestic product (GDP) per capita. For the quality-of-life improvement scenarios, the mean WTP/Q is RMB 78,907 (USD 11,777, 1.22 times GDP per capita), which is significantly lower than the life extension scenarios (RMB 177,761, USD 26,531, 2.76 times GDP per capita). Age was found to be negatively related to positive WTP. Educational level was positively related to the probability of reporting positive WTP and the level of WTP/Q. Although the EQ-5D-5L utility scores of respondents did not prove to be statistically significant determinants of WTP/Q, the two dimensions of EQ-5D-5L, pain/discomfort and anxiety/depression, had an impact on WTP/Q. In addition, WTP/Q was higher when the health outcome had a 50% probability of occurring than when the health outcome was 100% certain. WTP/Q was higher when a lower health gain was presented to the respondent. CONCLUSION This study provides empirical evidence of the monetary value of an additional QALY from a sample of the Chinese population. In addition, a higher threshold for end-of-life therapies should be considered.
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Affiliation(s)
- Ziping Ye
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
- School of Public Administration, Hainan University, Hainan, China
| | - Raela Abduhilil
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
| | - Jiaxin Huang
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
| | - Lihua Sun
- College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016 China
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Yanovskiy M, Socol Y. Are Lockdowns Effective in Managing Pandemics? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159295. [PMID: 35954650 PMCID: PMC9368251 DOI: 10.3390/ijerph19159295] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 01/27/2023]
Abstract
The present coronavirus crisis caused a major worldwide disruption which has not been experienced for decades. The lockdown-based crisis management was implemented by nearly all the countries, and studies confirming lockdown effectiveness can be found alongside the studies questioning it. In this work, we performed a narrative review of the works studying the above effectiveness, as well as the historic experience of previous pandemics and risk-benefit analysis based on the connection of health and wealth. Our aim was to learn lessons and analyze ways to improve the management of similar events in the future. The comparative analysis of different countries showed that the assumption of lockdowns’ effectiveness cannot be supported by evidence—neither regarding the present COVID-19 pandemic, nor regarding the 1918–1920 Spanish Flu and other less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: by using the known connection between health and wealth, we estimate that lockdowns may claim 20 times more life years than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown for either COVID-19 or any future pandemic.
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Kouakou CRC, Poder TG. Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:277-299. [PMID: 34417905 DOI: 10.1007/s10198-021-01364-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 05/12/2023]
Abstract
The use of a threshold for cost-utility studies is of major importance to health authorities for making the best allocation decisions for limited resources. Regarding the increasing number of studies worldwide that seek to establish a value for a quality-adjusted life year (QALY), it is necessary to review these studies to provide a global insight into the literature. A systematic review on willingness to pay (WTP) studies focusing on QALY was conducted in eight databases up to June 26, 2020. From a total of 9991 entries, 39 studies were selected, and 511 observations were extracted for the meta-analysis using the ordinary least squares method. The results showed a predicted mean empirical value of $52,619.39 (95% CI 49,952.59; 55,286.19) per QALY in US dollars for 2018. A 1% increase in income led to an increase of 0.6% in the WTP value, while a 1-year increase in respondent age led to a decrease of 3.3% in the WTP value. Sex, education level and employment status had significant effects on WTP. Compared to face-to-face interviews, surveys conducted by the internet or telephone were more likely to have a significantly higher value of WTP per QALY, while out-of-pocket payment tended to lower the value. The prediction made for the province of Quebec, Canada, provided a QALY value of approximately USD $98,450 (CAD $127,985), which is about 2.3 times its gross domestic product (GDP) per capita in 2018. This study is consistent with the extant literature and will be useful for countries that do not yet have a preference-based survey for the value of a QALY.
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Affiliation(s)
- Christian R C Kouakou
- Department of Economics, School of Business, University of Sherbrooke, Sherbrooke, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'Île de Montréal, Montreal, Canada
| | - Thomas G Poder
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'Île de Montréal, Montreal, Canada.
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, Canada.
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Bonander C, Svensson M. Using causal forests to assess heterogeneity in cost-effectiveness analysis. HEALTH ECONOMICS 2021; 30:1818-1832. [PMID: 33942950 DOI: 10.1002/hec.4263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
We develop a method for data-driven estimation and analysis of heterogeneity in cost-effectiveness analyses (CEA) with experimental or observational individual-level data. Our implementation uses causal forests and cross-fitted augmented inverse probability weighted learning to estimate heterogeneity in incremental outcomes, costs and net monetary benefits, as well as other parameters relevant to CEA. We also show how the results can be visualized in relevant ways for the analysis of heterogeneity in CEA, such as using individual-level cost effectiveness planes. Using a simulated dataset and an R package implementing our methods, we show how the approach can be used to estimate the average cost-effectiveness in the entire sample or in subpopulations, explore and analyze the heterogeneity in incremental outcomes, costs and net monetary benefits (and their determinants), and learn policy rules from the data.
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Affiliation(s)
- Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Ye Z, Liu F, Ma J, Zhou Z, Wang C, Sun L. Comparing the monetary value of a quality-adjusted life year from the payment card and the open-ended format. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:45. [PMID: 34281574 PMCID: PMC8287741 DOI: 10.1186/s12962-021-00298-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The payment card (PC) format and the open-ended (OE) format are common methods in eliciting willingness-to-pay (WTP) of one additional quality-adjusted life year (QALY). The aim of this research is to compare these two formats in eliciting the monetary value of a QALY. METHODS A contingent valuation survey was carried out using a pre-designed questionnaire with various hypothetical scenarios. The difference between the PC and the OE formats was evaluated by a two-sample equality test. Furthermore, generalized linear models were carried out to control observed heterogeneity and to test theoretical validity. RESULTS In total, 461 individuals were involved, among whom 235 (51%) answered the PC question, while 226 (49%) answered the OE question. Excluding zero response, the mean WTP values of these two formats for different scenarios varied dramatically, which was from 13,278 to 280,177 RMB for the PC, 18,119 to 620,913 RMB for the OE. The OE format tended to elicit lower values for less serious condition and higher values for more serious condition. However, equality test of mean and median demonstrated insignificant difference of these two formats for all scenarios. For both OE and PC format, most variables were found to have significant effect on the value of WTP/QALY. Moreover, joint estimation indicated a statistically significant positive effect on the OE results. Further analysis demonstrated that the imbalanced zero response distribution caused the main difference of these two formats. CONCLUSIONS This research indicated insignificantly different WTP/QALY estimates of the PC format and OE format with the grouped data whereas significantly higher estimates of the OE format from the pooled data. These two formats were found to be valid. More research about the difference and the validity of various WTP eliciting methods would be recommended for a robust estimation of WTP/QALY.
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Affiliation(s)
- Ziping Ye
- College of business administration, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Fuyao Liu
- College of business administration, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Jia Ma
- College of business administration, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Ziyang Zhou
- College of business administration, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Chen Wang
- College of business administration, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Lihua Sun
- College of business administration, Shenyang Pharmaceutical University, Shenyang, 110016, China.
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Ye Z, Ma J, Liu F, Wang C, Zhou Z, Sun L. A systematic review and meta-regression of studies eliciting willingness-to-pay per quality-adjusted life year in the general population. Expert Rev Pharmacoecon Outcomes Res 2021; 22:53-61. [PMID: 33464926 DOI: 10.1080/14737167.2021.1878881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES From the demand-side perspective, the monetary value of one additional quality-adjusted life year (QALY) is estimated as willingness-to-pay per QALY (WTPQ). This study aims to summarize the methods and contexts of elicitation of willingness-to-pay per quality-adjusted life year (WTPQ) in the general population and to investigate the heterogeneity of WTPQ estimates. METHODS Meta-regression analysis was conducted using Comprehensive Meta-Analysis Software. Sensitivity analyses were undertaken by replacing the lowest and highest 5% and 2.5% of WTPQ by percentiles. RESULTS 33 studies with 102 WTPQ estimates were included. The overall mean and median WTPQ estimates are $1,280,002 and $44,072, respectively. The meta-regressions demonstrated that types of health gain (quality of life or life length) and certainty of health outcomes are statistically significant factors. Furthermore, compared with online interviews, face-to-face interviews tend to yield lower WTPQ. Moreover, the declining trend of QALY gains and positive effect with statistical significance of the sample age were also noticed. CONCLUSION For valid and representative values of WTPQ, future researchers should therefore take into consideration various scenarios and investigate both health gain with certainty and uncertainty, health gain from both life length and quality of life, and different size of QALY gains.
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Affiliation(s)
- Ziping Ye
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Jia Ma
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Fuyao Liu
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Chen Wang
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Ziyang Zhou
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Lihua Sun
- School of business administration, Shenyang Pharmaceutical University, Shenyang, China
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Bazarbashi S, De Vol EB, Maraiki F, Al-Jedai A, Ali AA, Alhammad AM, Aljuffali IA, Iskedjian M. Empirical Monetary Valuation of a Quality-Adjusted Life-Year in the Kingdom of Saudi Arabia: A Willingness-to-Pay Analysis. PHARMACOECONOMICS-OPEN 2020; 4:625-633. [PMID: 32291726 PMCID: PMC7688848 DOI: 10.1007/s41669-020-00211-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND No willingness-to-pay (WTP) per quality-adjusted life-year (QALY) value exists for the Kingdom of Saudi Arabia (KSA). OBJECTIVE The primary objective of this study was to determine the WTP for a QALY in the KSA. METHODS Adult citizens of the KSA, patients with cancer, or members of the general public (MGP) were recruited to participate in a time trade-off survey to elicit health utilities. Cancer was chosen as the disease of interest for patients and the MGP, with a scenario describing stage 3 colorectal cancer, because it is a disease condition that impacts on both quality of life and survival time. In a second step, respondents were asked about their WTP to move from the estimated health state to a state of perfect health for 1 year (QALY). Finally, that amount was processed to generate the WTP for a full QALY. The second step was repeated with a 5-year horizon. Sensitivity analyses were performed without outliers. RESULTS From 400 participants, data from 378 subjects were obtained and usable: 177 patients, 201 MGP; 278 male, 100 female subjects; 231 aged 26-65 years. Demographic distribution varied widely between the two subgroups for age, education level, and employment status, but with less variation in sex and income. Elicited health utilities were 0.413 (0.472 after adjustment) for the overall group, 0.316 (0.416) for patients, and 0.499 (0.508) for MGP. Overall WTP for a QALY was $US25,600 (adjusted $US32,000) for the 1-year horizon and $US19,200 (adjusted $US22,720) for the 5-year horizon. CONCLUSION This was the first empirical attempt to estimate the WTP per QALY for the KSA. Results are comparable to those in some other countries and to gross domestic product figures for the KSA. Further research in a country-wide sample is warranted.
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Affiliation(s)
- Shouki Bazarbashi
- Section of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Edward B De Vol
- Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Fatma Maraiki
- Department of Pharmacy, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Al-Jedai
- Department of Pharmacy, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Afshan A Ali
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ali M Alhammad
- Drug Policy and Economics Center, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim A Aljuffali
- Department of Pharmaceutics, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Michael Iskedjian
- PharmIdeas USA Inc., 1967 Wehrle Drive, Unit 9, Williamsville, NY, 14221, USA.
- Associate Clinician, Faculty of Pharmacy, University of Montreal, Montreal, Canada.
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Herrera-Araujo D, Hammitt JK, Rheinberger CM. Theoretical bounds on the value of improved health. JOURNAL OF HEALTH ECONOMICS 2020; 72:102341. [PMID: 32531565 DOI: 10.1016/j.jhealeco.2020.102341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 05/17/2023]
Abstract
Policies that improve health and longevity are often valued by combining expected gains in quality-adjusted life years (QALYs) with a constant willingness-to-pay (WTP) per QALY. This constant is derived by dividing value per statistical life (VSL) estimates by expected future QALYs. We explore the theoretical validity of this practice by studying the properties of WTP for improved health and longevity in a framework that makes minimal assumptions about the shape of an agent's utility function. We find that dividing VSL by expected QALYs results in an upper bound on the WTP for a marginal improvement in the quality of life, as measured by gains in health status or longevity. Calibration results suggest that analysts using this approach to monetize health benefits overestimate the value of a program or policy by a factor of two on average. We also derive a lower bound on the WTP for improved health and longevity that permits a novel empirical test for the descriptive validity of the QALY model. Our calibrations suggest that this lower bound is on average 20% smaller than the actual WTP.
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Affiliation(s)
- Daniel Herrera-Araujo
- Université Paris-Dauphine, LEDa (CGEMP), UMR CNRS [8007], UMR IRD [260], PSL, Place du Maréchal de Lattre de Tassigny, 75016 Paris, France.
| | - James K Hammitt
- Harvard University (Center for Risk Analysis) and Toulouse School of Economics, Université Toulouse, France
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Vallejo-Torres L, García-Lorenzo B, Rivero-Arias O, Pinto-Prades JL. The societal monetary value of a QALY associated with EQ-5D-3L health gains. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:363-379. [PMID: 31782054 DOI: 10.1007/s10198-019-01140-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 11/14/2019] [Indexed: 05/26/2023]
Abstract
There is an extensive body of empirical research that focuses on the societal monetary value of a quality-adjusted life year (MVQALY). Many of these studies have found the estimates to be inversely associated with the size of the health gain, and thus not conforming to the linearity assumption imposed in the QALY model. In this study, we explore the extent to which the MVQALY varies when it is associated with different types and magnitudes of quality of life (QoL) improvements. To allow for a comprehensive assessment, we derive the MVQALY corresponding to the full spectrum of health gains defined by the EQ-5D-3L instrument. The analysis was based on a large and representative sample of the population in Spain. A discrete choice experiment and a time trade-off exercise were used to derive a value set for utilities, followed by a willingness to pay questionnaire. The data were jointly analysed using regression analyses and bootstrapping techniques. Our findings indicate that societal values for a QALY corresponding to different EQ-5D-3L health gains vary approximately between 10,000€ and 30,000€. MVQALY associated with larger improvements on QoL was found to be lower than that associated with moderate QoL gains. The potential sources of the observed non-constant MVQALY are discussed.
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Affiliation(s)
- Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Campus de Tafira, 35017, Las Palmas, Spain.
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), Canary Islands, Spain.
| | - Borja García-Lorenzo
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain
- Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Oliver Rivero-Arias
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Canary Islands, Spain
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Olofsson S, Gerdtham UG, Hultkrantz L, Persson U. Value of a QALY and VSI estimated with the chained approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1063-1077. [PMID: 31172400 DOI: 10.1007/s10198-019-01077-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/29/2019] [Indexed: 05/09/2023]
Abstract
The value of a quality-adjusted life-year (QALY) and the value of a statistical injury (VSI) are important measures within health economics and transport economics. Several studies have, therefore, estimated people's willingness to pay (WTP) for these estimates, but most results show scale insensitivity. The 'original' chained approach (CA) is a method developed to mitigate this problem by combining the contingent valuation (CV) with standard gamble (SG). In contrast to the version of the CA applied by the previous research of the WTP for a QALY, the original version allows the value of major health gains to be estimated without having the respondents express their WTP directly. The objective of this study was to estimate the value of a QALY and VSI in the context of non-fatal road traffic accidents using the original CA to test if the approach, applied to a wide range of health gains, is able to derive valid estimates and a constant value of a QALY which the previous research has not been able to show. Data were collected from a total of 800 individuals in the Swedish adult general population using two web-based questionnaires. The values of a QALY based on trimmed estimates were close to constant at €300,000 irrespective of the size of the QALY gain. The study shows that the original CA method may be a valid method to estimate the value of a QALY and VSI for major health losses. It also supports the use of a higher threshold value for a QALY than that which is currently applied by several health technology assessment agencies in different countries.
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Affiliation(s)
- S Olofsson
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden.
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
| | - U-G Gerdtham
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Department of Economics, School of Economics and Management, Lund University, Lund, Sweden
| | - L Hultkrantz
- School of Business, Örebro University, Örebro, Sweden
| | - U Persson
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden
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Lankarani KB, Ghahramani S, Moradi N, Shahraki HR, Lotfi F, Honarvar B. Willingness-to-Pay for One Quality-Adjusted Life-Year: A Population-Based Study from Iran. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:837-846. [PMID: 30123949 DOI: 10.1007/s40258-018-0424-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sulmaz Ghahramani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Najmeh Moradi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Farhad Lotfi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Olofsson S, Gerdtham UG, Hultkrantz L, Persson U. Measuring the end-of-life premium in cancer using individual ex ante willingness to pay. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:807-820. [PMID: 28803265 DOI: 10.1007/s10198-017-0922-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per quality-adjusted life-year (QALY) gained. Some HTA agencies accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so-called end-of-life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20-80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The mean value of a QALY was MSEK4.8 (€528,000), and there was an EoL premium of 4-10% at 6 months of expected remaining lifetime. Using subjective risk resulted in more robust and valid estimates of the value of a QALY. Order of scenarios did not have a significant impact on the WTP and the result showed scale sensitivity. Our result provides some support for the use of an EoL premium based on individual preferences when expected remaining lifetime is short and below 24 months. Furthermore, we find support for a value of a QALY that is above the current threshold of several HTA agencies.
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Affiliation(s)
- S Olofsson
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden.
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
| | - U-G Gerdtham
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- School of Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden
- Department of Economics, School of Economics and Management, Lund University, Lund, Sweden
| | - L Hultkrantz
- School of Business, Örebro University, Örebro, Sweden
| | - U Persson
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden
- School of Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden
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Vallejo-Torres L, García-Lorenzo B, Serrano-Aguilar P. Estimating a cost-effectiveness threshold for the Spanish NHS. HEALTH ECONOMICS 2018; 27:746-761. [PMID: 29282798 DOI: 10.1002/hec.3633] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 10/31/2017] [Accepted: 11/28/2017] [Indexed: 05/21/2023]
Abstract
The cost of generating a quality-adjusted life year (QALY) within a National Health Service provides an approximation of the average opportunity cost of funding decisions. This information can be used to inform a cost-effectiveness threshold. The aim of this paper is to estimate the cost per QALY at the Spanish National Health Service. We exploit variation across 17 regional health services and the exogenous changes in expenditure that took place as a consequence of the economic crisis over 5 years of data. We conduct fixed effect models and use an instrumental variable approach to test for potential remaining endogeneity. Our results show that health expenditure has a positive and significant effect on population health, with an average spending elasticity of 0.07. This translates into a cost per QALY of between 22,000€ and 25,000€. These values are below the cost-effectiveness threshold figure of 30,000€ commonly cited in Spain.
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Affiliation(s)
- Laura Vallejo-Torres
- Canary Islands Health Research Foundation (FUNCANIS), Tenerife, Canary Islands, Spain
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Canary Islands, Spain
- Spanish Network of Health Technology and Performance Assessment, Madrid, Spain
| | - Borja García-Lorenzo
- Canary Islands Health Research Foundation (FUNCANIS), Tenerife, Canary Islands, Spain
- Universistat Internacional de Catalunya, Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Canary Islands Health Research Foundation (FUNCANIS), Tenerife, Canary Islands, Spain
- Spanish Network of Health Technology and Performance Assessment, Madrid, Spain
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Canary Islands, Spain
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Cameron D, Ubels J, Norström F. On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review. Glob Health Action 2018; 11:1447828. [PMID: 29564962 PMCID: PMC5930346 DOI: 10.1080/16549716.2018.1447828] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/26/2018] [Indexed: 12/16/2022] Open
Abstract
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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Affiliation(s)
- David Cameron
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jasper Ubels
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fredrik Norström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Tilling C, Krol M, Attema AE, Tsuchiya A, Brazier J, van Exel J, Brouwer W. Exploring a new method for deriving the monetary value of a QALY. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:801-9. [PMID: 26289341 DOI: 10.1007/s10198-015-0722-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/05/2015] [Indexed: 05/07/2023]
Abstract
Several studies have sought to determine the monetary value of health gains expressed as quality adjusted life years (QALYs) gained, predominantly using willingness to pay approaches. However, willingness to pay has a number of recognized problems, most notably its insensitivity to scope. This paper presents an alternative approach to estimate the monetary value of a QALY, which is based on the time trade-off method. Moreover, it presents the results of an online study conducted in the Netherlands exploring the feasibility of this novel approach. The results seem promising, but also highlight a number of methodological problems with this approach, most notably nontrading and the elicitation of negative values. Additional research is necessary to try to overcome these problems and to determine the potential of this new approach.
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Affiliation(s)
- Carl Tilling
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marieke Krol
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Arthur E Attema
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Aki Tsuchiya
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Department of Economics, University of Sheffield, Sheffield, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Job van Exel
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Werner Brouwer
- Department of Health Policy and Management, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Vallejo-Torres L, García-Lorenzo B, Castilla I, Valcárcel-Nazco C, García-Pérez L, Linertová R, Polentinos-Castro E, Serrano-Aguilar P. On the Estimation of the Cost-Effectiveness Threshold: Why, What, How? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:558-66. [PMID: 27565273 DOI: 10.1016/j.jval.2016.02.020] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/02/2016] [Accepted: 02/28/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Many health care systems claim to incorporate the cost-effectiveness criterion in their investment decisions. Information on the system's willingness to pay per effectiveness unit, normally measured as quality-adjusted life-years (QALYs), however, is not available in most countries. This is partly because of the controversy that remains around the use of a cost-effectiveness threshold, about what the threshold ought to represent, and about the appropriate methodology to arrive at a threshold value. OBJECTIVES The aim of this article was to identify and critically appraise the conceptual perspectives and methodologies used to date to estimate the cost-effectiveness threshold. METHODS We provided an in-depth discussion of different conceptual views and undertook a systematic review of empirical analyses. Identified studies were categorized into the two main conceptual perspectives that argue that the threshold should reflect 1) the value that society places on a QALY and 2) the opportunity cost of investment to the system given budget constraints. RESULTS These studies showed different underpinning assumptions, strengths, and limitations, which are highlighted and discussed. Furthermore, this review allowed us to compare the cost-effectiveness threshold estimates derived from different types of studies. We found that thresholds based on society's valuation of a QALY are generally larger than thresholds resulting from estimating the opportunity cost to the health care system. CONCLUSIONS This implies that some interventions with positive social net benefits, as informed by individuals' preferences, might not be an appropriate use of resources under fixed budget constraints.
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Affiliation(s)
- Laura Vallejo-Torres
- Departamento de Economía Aplicada y Métodos Cuantitativos, Universidad de la Laguna; Centre for Biomedical Research of the Canary Islands (CIBICAN); Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Department of Applied Health Research, University College London, London, UK.
| | | | - Iván Castilla
- Centre for Biomedical Research of the Canary Islands (CIBICAN); Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna
| | - Cristina Valcárcel-Nazco
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Canary Foundation for Health Care Research (FUNCANIS)
| | - Lidia García-Pérez
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Canary Foundation for Health Care Research (FUNCANIS)
| | - Renata Linertová
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Canary Foundation for Health Care Research (FUNCANIS)
| | - Elena Polentinos-Castro
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Unidad Docente de Atención Familiar y Comunitaria Norte, Gerencia de Atención Primaria, Servicio Madrileño de Salud
| | - Pedro Serrano-Aguilar
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Canary Islands, Spain
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Svensson M, Nilsson FOL, Arnberg K. Reimbursement Decisions for Pharmaceuticals in Sweden: The Impact of Disease Severity and Cost Effectiveness. PHARMACOECONOMICS 2015; 33:1229-36. [PMID: 26093889 DOI: 10.1007/s40273-015-0307-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The Swedish Dental and Pharmaceutical Benefits Agency (TLV) is the government body responsible for deciding whether outpatient drugs are to be included in the pharmaceutical benefits scheme. This paper analyzes the impact of cost effectiveness and severity of disease on reimbursement decisions for new pharmaceuticals. METHODS Data has been extracted from all decisions made by the TLV between 2005 and 2011. Cost effectiveness is measured as the cost per quality-adjusted life-year (QALY) gained, whereas disease severity is a binary variable (severe-not severe). In total, the dataset consists of 102 decisions, with 86 approved and 16 declined reimbursements. RESULTS The lowest cost per QALY of declined reimbursements is Swedish kronor (SEK) 700,000 (€ 79,100), while the highest cost per QALY of approved reimbursements is SEK1,220,000 (€ 135,600). At a cost per QALY of SEK702,000 Swedish kronor (non-severe diseases) and SEK988,000 (severe diseases), the likelihood of approval is estimated to be 50/50 (€ 79,400 and € 111,700). CONCLUSIONS The TLV places substantial weight on both the cost effectiveness and the severity of disease in reimbursement decisions, and the implied willingness to pay for a QALY is higher than the often cited 'rule of thumb' in Swedish policy debates.
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Affiliation(s)
- Mikael Svensson
- Department of Economics, Örebro University, Fakultetsgatan 1, 701 82, Örebro, Sweden.
| | | | - Karl Arnberg
- The Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden
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Ryen L, Svensson M. The Willingness to Pay for a Quality Adjusted Life Year: A Review of the Empirical Literature. HEALTH ECONOMICS 2015; 24:1289-1301. [PMID: 25070495 DOI: 10.1002/hec.3085] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 05/05/2014] [Accepted: 06/20/2014] [Indexed: 05/07/2023]
Abstract
There has been a rapid increase in the use of cost-effectiveness analysis, with quality adjusted life years (QALYs) as an outcome measure, in evaluating both medical technologies and public health interventions. Alongside, there is a growing literature on the monetary value of a QALY based on estimates of the willingness to pay (WTP). This paper conducts a review of the literature on the WTP for a QALY. In total, 24 studies containing 383 unique estimates of the WTP for a QALY are identified. Trimmed mean and median estimates amount to 74,159 and 24,226 Euros (2010 price level), respectively. In regression analyses, the results indicate that the WTP for a QALY is significantly higher if the QALY gain comes from life extension rather than quality of life improvements. The results also show that the WTP for a QALY is dependent on the size of the QALY gain valued. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Linda Ryen
- Department of Economics, Karlstad University, Karlstad, Sweden
| | - Mikael Svensson
- Department of Economics, Karlstad University, Karlstad, Sweden
- Department of Economics, Örebro University, Örebro, Sweden
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Nimdet K, Chaiyakunapruk N, Vichansavakul K, Ngorsuraches S. A systematic review of studies eliciting willingness-to-pay per quality-adjusted life year: does it justify CE threshold? PLoS One 2015; 10:e0122760. [PMID: 25855971 PMCID: PMC4391853 DOI: 10.1371/journal.pone.0122760] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A number of studies have been conducted to estimate willingness to pay (WTP) per quality-adjusted life years (QALY) in patients or general population for various diseases. However, there has not been any systematic review summarizing the relationship between WTP per QALY and cost-effectiveness (CE) threshold based on World Health Organization (WHO) recommendation. OBJECTIVE To systematically review willingness-to-pay per quality-adjusted-life-year (WTP per QALY) literature, to compare WTP per QALY with Cost-effectiveness (CE) threshold recommended by WHO, and to determine potential influencing factors. METHODS We searched MEDLINE, EMBASE, Psyinfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Center of Research Dissemination (CRD), and EconLit from inception through 15 July 2014. To be included, studies have to estimate WTP per QALY in health-related issues using stated preference method. Two investigators independently reviewed each abstract, completed full-text reviews, and extracted information for included studies. We compared WTP per QALY to GDP per capita, analyzed, and summarized potential influencing factors. RESULTS Out of 3,914 articles founded, 14 studies were included. Most studies (92.85%) used contingent valuation method, while only one study used discrete choice experiments. Sample size varied from 104 to 21,896 persons. The ratio between WTP per QALY and GDP per capita varied widely from 0.05 to 5.40, depending on scenario outcomes (e.g., whether it extended/saved life or improved quality of life), severity of hypothetical scenarios, duration of scenario, and source of funding. The average ratio of WTP per QALY and GDP per capita for extending life or saving life (2.03) was significantly higher than the average for improving quality of life (0.59) with the mean difference of 1.43 (95% CI, 1.81 to 1.06). CONCLUSION This systematic review provides an overview summary of all studies estimating WTP per QALY studies. The variation of ratio of WTP per QALY and GDP per capita depended on several factors may prompt discussions on the CE threshold policy. Our research work provides a foundation for defining future direction of decision criteria for an evidence-informed decision making system.
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Affiliation(s)
- Khachapon Nimdet
- Faculty of Pharmaceutical Sciences, Prince Songkla University, Hatyai, Thailand
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, United States of America
- School of Population Health, University of Queensland, Brisbane, Australia
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On the margins of health economics: a response to 'resolving NICE'S nasty dilemma'. HEALTH ECONOMICS, POLICY, AND LAW 2015; 10:183-93. [PMID: 25747196 DOI: 10.1017/s1744133114000462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In a 2011 article published in this journal, Baker et al. set out to resolve a nasty dilemma for NICE by reconciling two approaches for determining whether adopting a new intervention would increase total health gains produced from available resources and hence increase system efficiency. In this response we show how the proposed reconciliation, as well as the two approaches on which it is based, fail to inform decision makers about the efficiency of a new intervention. We show how this arises from the misuse of incremental costs and effects of between-intervention comparisons as measures of changes in costs and effects associated with marginal adjustments to the scale of an intervention. Ironically, incremental data represent the choices faced by decision makers and we illustrate a method for determining unambiguously whether a new intervention represents an improvement in efficiency.
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Pennington M, Baker R, Brouwer W, Mason H, Hansen DG, Robinson A, Donaldson C. Comparing WTP values of different types of QALY gain elicited from the general public. HEALTH ECONOMICS 2015; 24:280-93. [PMID: 25625510 DOI: 10.1002/hec.3018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 09/13/2013] [Accepted: 11/06/2013] [Indexed: 05/07/2023]
Abstract
BACKGROUND The appropriate thresholds for decisions on the cost-effectiveness of medical interventions remain controversial, especially in 'end-of-life' situations. Evidence of the values placed on different types of health gain by the general public is limited. METHODS Across nine European countries, 17,657 people were presented with different hypothetical health scenarios each involving a gain of one quality adjusted life year (QALY) and asked about their willingness to pay (WTP) for that gain. The questions included quality of life (QoL) enhancing and life extending health gains, and a scenario where respondents faced imminent, premature death. RESULTS The mean WTP values for a one-QALY gain composed of QoL improvements were modest (PPP$11,000). When comparing QALY gains obtained in the near future, the valuation of life extension exceeded the valuation of QoL enhancing gains (mean WTP PPP$19,000 for a scenario in which a coma is avoided). The mean WTP values were higher still when respondents faced imminent, premature death (PPP$29,000). CONCLUSIONS Evidence from the largest survey on the value of health gains by the general public indicated a higher value for life extending gains compared with QoL enhancing gains. A further modest premium may be indicated for life extension when facing imminent, premature death.
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Martín-Fernández J, Polentinos-Castro E, del Cura-González MI, Ariza-Cardiel G, Abraira V, Gil-LaCruz AI, García-Pérez S. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences. BMC Health Serv Res 2014; 14:287. [PMID: 24989615 PMCID: PMC4083040 DOI: 10.1186/1472-6963-14-287] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 06/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Methods Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games. Results Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. Conclusions WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning.
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Affiliation(s)
- Jesus Martín-Fernández
- Consultorio Local de Villamanta (C,S Navalcarnero), Gerencia de Atención Primaria, Servicio Madrileño de Salud, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Avda de la Libertad s/n, Villamanta 28610, Madrid, Spain.
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Montesino-Semper MF, Jimenez-Calvo JM, Cabases JM, Sanchez-Iriso E, Hualde-Alfaro A, García-García D. Cost-effectiveness analysis of the surgical treatment of female urinary incontinence using slings and meshes. Eur J Obstet Gynecol Reprod Biol 2013; 171:180-6. [DOI: 10.1016/j.ejogrb.2013.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 08/02/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
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Robinson A, Gyrd-Hansen D, Bacon P, Baker R, Pennington M, Donaldson C. Estimating a WTP-based value of a QALY: the 'chained' approach. Soc Sci Med 2013; 92:92-104. [PMID: 23849283 DOI: 10.1016/j.socscimed.2013.05.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 11/26/2022]
Abstract
A major issue in health economic evaluation is that of the value to place on a quality adjusted life year (QALY), commonly used as a measure of health care effectiveness across Europe. This critical policy issue is reflected in the growing interest across Europe in development of more sound methods to elicit such a value. EuroVaQ was a collaboration of researchers from 9 European countries, the main aim being to develop more robust methods to determine the monetary value of a QALY based on surveys of the general public. The 'chained' approach of deriving a societal willingness-to-pay (WTP) based monetary value of a QALY used the following basic procedure. First, utility values were elicited for health states using the standard gamble (SG) and time trade off (TTO) methods. Second, a monetary value to avoid some risk/duration of that health state was elicited and the implied WTP per QALY estimated. We developed within EuroVaQ an adaptation to the 'chained approach' that attempts to overcome problems documented previously (in particular the tendency to arrive at exceedingly high WTP per QALY values). The survey was administered via Internet panels in each participating country and almost 22,000 responses achieved. Estimates of the value of a QALY varied across question and were, if anything, on the low side with the (trimmed) 'all country' mean WTP per QALY ranging from $18,247 to $34,097. Untrimmed means were considerably higher and medians considerably lower in each case. We conclude that the adaptation to the chained approach described here is a potentially useful technique for estimating WTP per QALY. A number of methodological challenges do still exist, however, and there is scope for further refinement.
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Affiliation(s)
- Angela Robinson
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
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Field RI, Caplan AL. Evidence-based decision making for vaccines: The need for an ethical foundation. Vaccine 2012; 30:1009-13. [DOI: 10.1016/j.vaccine.2011.12.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/08/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
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