Abstract
BackgroundDue to the lack of a constant Willingness to Pay per one additional Quality Adjusted Life Years gained based on the preferences of Iran’s general public, the cost-effectiveness of health system interventions is unclear and making it challenging to apply economic evaluation to health resources priority setting.MethodsWe have measured this cost-effectiveness threshold with the participation of 2854 individuals from five provinces, each representing an income quintile, using a modified Time Trade-Off-based Chained-Approach. In this online-based empirical survey, to extract the health utility value, participants were randomly assigned to one of two green (21121) and yellow (22222) health scenarios designed based on the earlier validated EQ-5D-3L questionnaire.ResultsAcross the two health state versions, mean values for one QALY gain (rounded) ranged from $6740-$7400 and $6480-$7120, respectively, for aggregate and trimmed models, which are equivalent to 1.35-1.18 times of the GDP per capita. Log-linear Multivariate OLS regression analysis confirmed that respondents were more likely to pay if their income, disutility, and education level were higher than their counterparts.ConclusionsIn the health system of Iran, any intervention that is with the incremental cost-effectiveness ratio, equal to and less than 7402.12 USD, will be considered cost-effective.
Highlights
Introduction of chained approachTo derive a cost-effectiveness threshold, which means the maximum monetary value of one year of full quality, we have developed a Chain Approach using a two-step process
We considered the 0.1 Quality-Adjusted Life Years (QALY) gained as an equal valuation baseline for all the hypothetical scenarios
Health scenarios and utilities In the second part of the questionnaire, we defined two hypothetical health conditions of Green and Yellow health state scenarios. These health scenarios were determined based on five dimensions of health in the European Quality of Life Five Dimension Five Level Scale (EQ-5D-3L) questionnaire, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression These dimensions are defined in three levels of no problems, some problems, and extreme problems
Summary
Introduction of chained approachTo derive a cost-effectiveness threshold, which means the maximum monetary value of one year of full quality, we have developed a Chain Approach using a two-step process. The value of WTP per QALY, known as the cost-effectiveness threshold, has been measured in developed countries through cross-sectional empirical surveys and is updating over time [7] These studies are highly heterogeneous in terms of sample size, level of study, type of sample, extraction tools of health utility values, scenarios depicting health status with varying degrees of severity, and overall study planning [8,9,10]. Their results have different validity and generalizability, and Jahanbin et al BMC Health Services Research (2021) 21:1339 they produce very mixed results even for the same populations [10]
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