Willingness to pay for one quality-adjusted life year in Iran

Najmeh Moradi,Leila Zarei,Alireza Olyaeemanesh,Arash Rashidian,Shirin Nosratnejad,Marzieh Zanganeh

doi:10.1186/s12962-019-0172-9

Abstract

BackgroundRecent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies. One such measure is the use of the cost-effectiveness threshold as a benchmark. This study explored the threshold for use in the health system of Iran by determining society’s preferences.MethodsA cross-sectional household survey based on the contingent valuation method was administered to a representative general population of 1002 in Tehran, Iran from April to June 2015. The survey was intended to estimate the respondents’ willingness-to-pay (WTP) preferences for one quality-adjusted life year (QALY) gained. The valuation scenarios featured 12 vignettes on mild to severe diseases that can change people’s quality of life. The mean of WTP for QALY was estimated using different health instruments, and the determinants of such willingness were analyzed using the Heckman selection model.ResultsWTP for QALY varied depending on the severity of a disease and the instrument used to determine health preferences. Mean low health state value were associated with high valuation. The best estimated WTP values ranged from US$1032 to US$2666 and 0.22–0.56 of Iran’s local gross domestic product (GDP) per capita in 2014. Except for educational level, significant variables differed across different disease scenarios. Generally, a high health state valuation for target diseases, high income, high educational level, and being married were associated with high WTP for QALY.ConclusionFrom the general public’s perspective, the monetary value of QALY for mild to severe diseases with no risk of death was less than one GDP per capita. Therefore, the obtained valuation range is recommended as reference only for the adoption of interventions designed to improve quality of life. Future studies should estimate the threshold of interventions for life-threatening diseases or formulate transparent policies in such contexts.

Highlights

Recent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies
Moradi et al Cost Eff Resour Alloc (2019) 17:4 shortcoming of cost-effectiveness analysis (CEA), is that the result of analysis is only a numerical value that indicates, in comparison with alternatives, which quality-adjusted life year (QALY) are cheaper. This is minimally comprehensible to policy makers and fails to offer an acceptable solution to the issue of which intervention offers the best value for money or how much cost per QALY should be acceptable and worth investing in given the resources available to a national health care system [6]
The only measure used in the country is the World Health Organization’s (WHO) recommendation for choosing cost-effective interventions based on a country gross domestic product (GDP) per capita

Summary

Introduction

Recent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies One such measure is the use of the cost-effectiveness threshold as a benchmark. Moradi et al Cost Eff Resour Alloc (2019) 17:4 shortcoming of CEA, is that the result of analysis is only a numerical value (i.e., incremental cost per QALY) that indicates, in comparison with alternatives, which QALYs are cheaper This is minimally comprehensible to policy makers and fails to offer an acceptable solution to the issue of which intervention offers the best value for money or how much cost per QALY should be acceptable and worth investing in given the resources available to a national health care system [6]. Based on this statement, spending per capita estimated value to achieve one extra healthy life year was reasonable [14, 15]

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