Abstract
BackgroundCost-effectiveness analysis provides a crucial means for evidence-informed decision-making on resource allocation. This study aims to elicit individuals' willingness to pay (WTP) for one additional quality-adjusted life-year (QALY) gained from life-saving treatment and associated factors in Kermanshah city, western Iran.MethodsWe conducted a cross-sectional study on a total of 847 adults aged 18 years and above to elicit their WTP for one additional QALY gained by oneself and a family member using a hypothetical life-saving treatment. We used a multistage sampling technique to select the samples, and the Iranian version of EQ-5D-3L, and visual analogue scale (VAS) measures to obtain the participants’ health utility value. The Tobit regression model was used to identify the factors affecting WTP per QALY values.ResultsThe mean WTP value and standard deviation (SD) was US$ 862 (3,224) for the respondents. The mean utility values using EQ-5D-3L and VAS methods for respondents were 0.779 and 0.800, respectively. Besides, the WTP for the additional QALY gained by the individual participants using the EQ-5D-3L and VAS methods were respectively US$ 1,202 and US$ 1,101, while the estimated value of the family members was US$ 1,355 (SD = 3,993). The Tobit regression models indicated that monthly income, education level, sex, and birthplace were statistically significantly associated (p < 0.05) with both the WTP for the extra QALY values using the EQ-5D-3L and the VAS methods. Educational level and monthly income also showed statistically significant relationships with the WTP for the additional QALY gained by the family members (p < 0.05).ConclusionOur findings indicated that the participants' WTP value of the additional QALY gained from the hypothetical life-saving treatment was in the range of 0.20–0.24 of the gross domestic product (GDP) per capita of Iran. This value is far lower than the World Health Organization (WHO) recommended CE threshold value of one. This wide gap reflects the challenges the health system is facing and requires further research for defining the most appropriate CE threshold at the local level.
Highlights
Cost-effectiveness analysis provides a crucial means for evidence-informed decision-making on resource allocation
The univariate analysis indicated that gender, educational status, health insurance coverage, birthplace, and monthly income were statistically significantly associated with the willingness to pay (WTP) for the lifesaving treatment
The pattern of WTP responses The findings showed a higher mean WTP value for a family member (US$ 1,355 ± standard deviation (SD) 3,993) than for the individual participant (US$ 862 ± SD 3,224)
Summary
Cost-effectiveness analysis provides a crucial means for evidence-informed decision-making on resource allocation. An intervention is considered cost-effective [7] if the ICER value lies below an established threshold value, and vice versa [5, 8]. Despite this commonly used approach, there is no single standard to estimate the CE threshold [9]. The World Health Organization (WHO) considers that if the incremental cost to incremental QALYs gained ratio is less than one, or a value of one to three times the per capita GDP as cost-effective intervention, with the higher value unacceptable [10, 11]
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