Contingent Valuation of Eight New Treatments: What is the Clinician's and Politician's Willingness to Pay?

Abstract

Objective: To assess the willingness to pay (WTP) for eight new treatments from a life-long perspective. Methods: A contingent valuation with virtual examples and dichotomous choice questions is circulated to Finnish clinicians (N 146) and politicians (N 73). Costs and utilities (15D, EQ-5D) are obtained from Finnish sources, and the health care payer perspective is assumed. Health benefits are measured using life-years gained (LYG) and quality-adjusted life-years (QALY) gained, and 3% and 0% annual discounting is done. The results are presented as different WTP thresholds (incremental and aggregate cost-effectiveness ratios, and incremental investments, II). Heterogeneity is handled using conditional (Hurdle) modeling. Results: In 1,092 decisions, the mean discounted (undiscounted) incremental WTP/QALY gained is €102,616 (€78,686) and €94,770 (€77,856) measured with 15D and EQ-5D, respectively. The mean discounted (undiscounted) incremental WTP/LYG is €66,277 (€58,160). The highest incremental WTPs are reported for cancer (€205,994-250,509/QALY gained) and lowest for metabolic disease (€23,492-43,398/QALY gained) treatment. The discounted (undiscounted) IIs to health care are €83,886 (€85,398) Euros; metabolic presenting the highest (€199,499-213,808) and coronary heart disease treatment (€36,124-36,736) the lowest value for the lifetime of the patient. WTP is dependent upon disease/treatment, patient's age, time preference, health benefit type and discounting. Minor differences between clinicians and politicians are observed. Conclusion: WTP vary for different diseases and is not explained by incremental costs. Thus, a single WTP for all treatments/diseases hypothesis do not gain empirical support - WTP is better explained by treatment and patient/disease characteristics. Cost-effectiveness and II have a trade-off, which encourages studies including both efficiency and affordability.