Willingness to Pay for a Quality-Adjusted Life-Year: The Individual Perspective

Authors

  • Ana Bobinac MSc,

    1. Department of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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  • N. J. A. Van Exel MSc,

    1. Department of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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  • Frans F. H. Rutten PhD,

    1. Department of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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  • Werner B. F. Brouwer PhD

    1. Department of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Ana Bobinac, Erasmus University Rotterdam (iBMG / iMTA), PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: a.bobinac@erasmusmc.nl

ABSTRACT

Objective:  The aim of this study was to elicit the individual willingness to pay (WTP) for a quality-adjusted life-year (QALY).

Methods:  In a Web-based questionnaire containing contingent valuation exercises, respondents valued health changes in five scenarios. In each scenario, the respondents first valued two health states on a visual analog scale (VAS) and expressed their WTP for avoiding a decline in health from the better health state to the worse, using a payment scale followed by a bounded open contingent valuation question.

Analysis:  WTP per QALY was calculated for QALY gains calculated using VAS valuations, as well as the Dutch EQ-5D tariffs, the two steps in the WTP estimations and each scenario. Heterogeneity in WTP per QALY ratios was examined from the perspective of: 1) household income; and 2) the level of certainty in WTP indicated by respondents. Theoretical validity was analyzed using clustered multivariate regressions.

Results:  A total of 1091 respondents, representative of the Dutch population, participated in the survey. Mean WTP per QALY was €12,900 based on VAS valuations, and €24,500 based on the Dutch EuroQoL tariffs. WTP per QALY was strongly associated with income, varying from €5000 in the lowest to €75,400 in the highest income group. Respondents indicating higher certainty exhibited marginally higher WTP. Regression analyses confirmed expected relations between WTP per QALY, income, and other personal characteristics.

Conclusion:  Individual WTP per QALY values elicited in this study are similar to those found in comparable studies. The use of individual valuations in social decision-making deserves attention, however.

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