Abstract
BackgroundIn health economic evaluation, utility associated with a health state is outcome-oriented and usually measured using the QALY methodology. Even though there is consistent evidence of utility not only being derived from outcomes but also from procedures, process utility has not been fully integrated in QALY calculations. The aim of this paper is twofold: first, to provide evidence of process utility associated with an alternative treatment to angioplasty, and second, to estimate a monetary value of such process utility using the willingness to pay (WTP) approach.MethodsA total of 1514 people were polled on their WTP to avoid angioplasty to have a drug-eluting stent (DES) implanted. WTP is estimated with a contingent valuation (CV) survey. Individuals are also asked if they would be WTP for a non-invasive procedure with similar results being achieved. WTP responses were analyzed using a double bounded (DB) logit model.ResultsMost of the participants showed positive preferences for avoiding angioplasty, with an estimated mean WTP of €5692.87. Using QALY gains for avoiding angioplasty, varying from 0.0035 to 0.08 QALYs, our WTP estimate imply monetary values per QALY that range from €71,160.87 to €1,626,534.28.DiscussionA WTP of €5692.87 to avoid angioplasty imply a monetary value per QALY that greatly exceed the cost per QALY thresholds established in different countries to consider health programs as beneficial to society. Our results reflect how different methodologies for HTA may lead to different conclusions. From the ICER perspective, the cost that would make the treatment with pills option cost-effective, using a threshold of €40,000/QALY, would be €224. However, a cost-benefit approach could support health programs even with a higher cost.ConclusionWTP methodology captures outcome and process factors related to angioplasty as our WTP estimations are non-significantly different for the costs of angioplasty. WTP approach must be considered as a genuine alternative to QALY approaches to value process utility.
Highlights
In health economic evaluation, utility associated with a health state is outcome-oriented and usually measured using the quality-adjusted life years (QALYs) methodology
A total of 1514 participants reached the second part of the questionnaire. 114 individuals preferred treating restenosis undergoing an angioplasty over the treatment with pill and were not willing to pay for this option
Responses to the initial question on preferences for treating restenosis with either angioplasty or by swallowing a pill are clear: 92.5% of the respondents opt for the treatment with pills
Summary
Utility associated with a health state is outcome-oriented and usually measured using the QALY methodology. Restenosis is treated in both cases, given a choice with two options individuals value other aspects of procedures and may have preferences for the non-invasive procedure, as in [10,11,12,13]. These attributes in process of health care enter the utility function [14, 15], have quality of life implications for the individual [16] and can be incorporated into estimates of QALY calculations [17, 18]. The theoretical background for process utility entering the QALY estimations was first introduced by Gerard and Mooney (1993) [15]
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