Abstract
BackgroundThis paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response.MethodsHealth-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games.ResultsSix hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results.ConclusionsWTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning.
Highlights
This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response
A decrease in risk seeking behavior has been reported as the subject has to pay higher prices [21], and patients in need of a specific treatment that restores full health expressed a lower willingness to pay than the ex-ante estimated WTP, when individuals were risk averse [22]. For these reasons it is relevant to analyze the role of attitude towards risk in elicitation of WTP/QALY ratios. We find it necessary to extend the study of the threshold of acceptability for paying for a QALY: firstly, by further studying different geographical and social contexts, and secondly, by including new elements, which allow for the identification of personal characteristics that can contribute to variability in the expressed valuation
The objective of the current study is to evaluate the expression of WTP for a gained QALY by people who attend the healthcare system and assess the personal characteristics that are related to this response, paying particular attention to the attitude towards risk of the subjects
Summary
This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. From the side of demand, considering the relevant threshold as the monetary value society places on marginal health gains, the value of the QALY can be empirically estimated with some preference elicitation method, such as the contingent valuation (CV) method. This method consists of directly asking subjects about their Willingness to Pay (WTP) for a good or service, building a hypothetical scenario where the interviewees play the role of demand and the interviewer plays the role of the supply [7]. When evaluating the results of this type of studies, the adopted perspective (ex-ante, previous to the existence of the need, versus ex-post, when the health need already exists) should be considered
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