Abstract
BackgroundIn economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. Although JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value?MethodsTo examine the relationship between severity of health status and monetary value of a QALY, we obtained willingness to pay (WTP) values for one additional QALY in eight patterns of health states. We randomly sampled approximately 2,400 respondents from an online panel. To avoid misunderstanding, we randomly allocated respondents to one of 16 questionnaires, with 250 responses expected for each pattern. After respondents were asked whether they wanted to purchase the treatment, double-bounded dichotomous choice method was used to obtain WTP values.ResultsThe results clearly show that the WTP per QALY is higher for worse health states than for better health states. The slope was about JPY −1 million per 0.1 utility score increase. The mean and median WTP values per QALY for 16 health states were JPY 5 million, consistent with our previous survey. For respondents who wanted to purchase the treatment, WTP values were significantly correlated with household income.ConclusionThis survey shows that QALY based on the EQ-5D does not necessarily have the same monetary value. The WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states.
Highlights
In economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator of costeffectiveness [1,2]
For respondents who wanted to purchase the treatment, willingness to pay (WTP) values were significantly correlated with household income
Based on the results of regression analysis (Figure. 1), the WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states
Summary
Cost per quality-adjusted life year (QALY) is generally used as an indicator of costeffectiveness [1,2]. Cost-effectiveness of healthcare technologies is often discussed by comparing ICER with a threshold, i.e., ₤20,000-₤30,000 per QALY according to the National Institute for Health and Care Excellence (NICE) guidelines [5]. This threshold is not explicitly stratified by other factors, which are qualitatively considered at the time of appraisal or decision making. Cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value?
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