Willingness to Pay per QALY: A Systematic Review of Demand-Side Valuations with a Focus on Age and Disease Severity.

IF 3.3 4区 医学 Q1 ECONOMICS
Marios Athanasios Loupas, Kostas Athanasakis, Dimitris Zavras
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引用次数: 0

Abstract

Background: Willingness-to-pay (WTP) studies offer a demand-side perspective on the monetary value of health gains, typically expressed as WTP per quality-adjusted life year (WTP/Q). These estimates can complement supply-side cost-effectiveness thresholds (CETs) and inform whether healthcare budgets align with public preferences. However, existing thresholds often overlook heterogeneity by condition or population characteristics.

Objective: This study sought to systematically review literature on WTP/Q estimates derived from stated preference methods by (i) mapping the broader landscape of demand-side valuations and (ii) synthesizing how WTP/Q varies by both respondent and scenario-assigned age and disease severity in general-health contexts.

Methods: A systematic review was conducted across Medline, Embase, and EconLit, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies estimated the monetary value of a quality-adjusted life year (QALY) from a societal, demand-side perspective. We first conducted a broad narrative mapping of all included studies to describe methodological characteristics and contextual diversity. We then focused on a subset of studies using general-health scenarios to explore how willingness to pay per QALY varied by age and severity. A structured four-axis framework was applied to distinguish between respondent characteristics and scenario-assigned attributes. Data were classified and tabulated. A formal quality assessment was conducted across the full set of studies using the National Institutes of Health (NIH) tool.

Results: A total of 67 studies met inclusion criteria. Most originated from high-income countries and used contingent valuation or discrete choice experiments. Among general-health studies, WTP/Q decreased with respondents' actual age in 49% of studies and increased with respondents' own health severity in 79%. In studies assessing scenario-assigned attributes, WTP/Q increased with hypothetical disease severity in 91% of studies and decreased with scenario-assigned age in 83%. Substantial heterogeneity was observed in elicitation methods, framing, and utility measurement.

Conclusions: The findings support the need for condition- and population-specific WTP thresholds, as valuations appear to vary depending on the nature of the health gain and the characteristics of the beneficiary-whether real or hypothetical.

按质量支付意愿:需求侧评估的系统回顾,关注年龄和疾病严重程度。
背景:支付意愿(WTP)研究提供了对健康收益货币价值的需求侧观点,通常表示为每质量调整生命年的WTP/Q。这些估算可以补充供应方成本效益阈值(cet),并告知医疗保健预算是否符合公众偏好。然而,现有的阈值往往忽略了条件或群体特征的异质性。目的:本研究试图通过(i)绘制需求侧估值的更广泛图景,以及(ii)综合WTP/Q在一般健康背景下如何随被调查者和场景指定年龄和疾病严重程度而变化,系统地回顾有关从陈述偏好方法得出的WTP/Q估计的文献。方法:遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目,对Medline、Embase和EconLit进行了系统评价。符合条件的研究从社会需求角度估计了质量调整生命年(QALY)的货币价值。我们首先对所有纳入的研究进行了广泛的叙事映射,以描述方法特征和上下文多样性。然后,我们将重点放在使用一般健康方案的研究子集上,以探索每个QALY的支付意愿如何随年龄和严重程度而变化。采用结构化的四轴框架来区分受访者特征和场景分配属性。数据被分类并制成表格。使用美国国立卫生研究院(NIH)的工具对全套研究进行了正式的质量评估。结果:共有67项研究符合纳入标准。大多数来自高收入国家,使用条件评估或离散选择实验。在一般健康研究中,49%的研究中WTP/Q随受访者的实际年龄而下降,79%的研究中WTP/Q随受访者自身健康严重程度而增加。在评估情景分配属性的研究中,91%的研究中WTP/Q随假设的疾病严重程度而增加,83%的研究中WTP/Q随情景分配的年龄而降低。在启发方法、框架和效用测量中观察到实质性的异质性。结论:研究结果支持对特定条件和人群的WTP阈值的需求,因为估值似乎根据健康收益的性质和受益人的特征(无论是真实的还是假设的)而变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Applied Health Economics and Health Policy
Applied Health Economics and Health Policy Economics, Econometrics and Finance-Economics and Econometrics
CiteScore
6.10
自引率
2.80%
发文量
64
期刊介绍: Applied Health Economics and Health Policy provides timely publication of cutting-edge research and expert opinion from this increasingly important field, making it a vital resource for payers, providers and researchers alike. The journal includes high quality economic research and reviews of all aspects of healthcare from various perspectives and countries, designed to communicate the latest applied information in health economics and health policy. While emphasis is placed on information with practical applications, a strong basis of underlying scientific rigor is maintained.
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