Research Article

International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?

  1. Takeru Shiroiwa1,*,
  2. Yoon-Kyoung Sung2,
  3. Takashi Fukuda3,
  4. Hui-Chu Lang4,
  5. Sang-Cheol Bae2,
  6. Kiichiro Tsutani1

Article first published online: 20 APR 2009

DOI: 10.1002/hec.1481

Issue

Health Economics

Health Economics

Volume 19, Issue 4, pages 422–437, April 2010

Additional Information

How to Cite

Shiroiwa, T., Sung, Y.-K., Fukuda, T., Lang, H.-C., Bae, S.-C. and Tsutani, K. (2010), International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?. Health Econ., 19: 422–437. doi: 10.1002/hec.1481

Author Information

  1. 1

    Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan

  2. 2

    Department of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea

  3. 3

    Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan

  4. 4

    Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan

*Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan

Publication History

  1. Issue published online: 10 MAR 2010
  2. Article first published online: 20 APR 2009
  3. Manuscript Accepted: 12 FEB 2009
  4. Manuscript Revised: 13 JAN 2009
  5. Manuscript Received: 13 JUN 2008

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Keywords:

  • cost-effectiveness analysis;
  • threshold;
  • QALY;
  • WTP;
  • double-bound dichotomous choice

Abstract

Although the threshold of cost effectiveness of medical interventions is thought to be £20 000–£30 000 in the UK, and $50 000–$100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), £23 000 (UK), AU$ 64 000 (Australia), and US$ 62 000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making. Copyright © 2009 John Wiley & Sons, Ltd.

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