Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

Abstract

BackgroundThis 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.MethodsHealth-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.ResultsSix 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.ConclusionsWTP/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.

Evaluación económica busca umbral para apoyar la toma de decisiones

“…Estos estudios emplearon ambas perspectivas descritas, aunque la mayoría se centraban en estimar el valor social de las ganancias en salud [25][26][27][28][29] y únicamente un trabajo 30 estimó el coste por AV en el sistema español. Otros dos estudios se basaron en una revisión de evaluaciones económicas 16,31 .…”

“…A pesar de disponer de estimaciones del umbral CE en España 16,[25][26][27][28][29][30][31] , ninguna de las cifras disponibles es formalmente reconocida en la toma de decisiones. El panel de expertos mostró un consenso general sobre la necesidad de fijar un umbral explícito para España.…”

Understanding the global measurement of willingness to pay in health

“…One implication of this approach is the "dead anyway effect that asserts that VSL increases with baseline risk [10]. The WTP approach on the other hand directly relates to the value of a quality adjusted life year (QALY), by asking respondents how much they are willing to spend for a certain health gain in terms of quality and lengths of life [11]. Quality of life is usually measured by utility values that are in turn elicited by either standard gable or time trade off methods.…”

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

“…Participants may exaggerate willingness-to-pay values and in real life do not necessarily behave the same way as stated in their responses [23].…”