Presentation (CTI)

OBJECTIVES: This study aimed to determine an appropriate cost-effectiveness threshold (CET) based on willingness to pay (WTP) per quality-adjusted life-year (QALY) (WTP-Q) for healthcare interventions in Quebec, Canada.
METHODS: WTP values were estimated based on different scenarios adjusted for various time horizons: a few weeks (representing the final stages of life), 10, and 20 years. An online survey was conducted using a single-bounded dichotomous choice (SBDC) method. Heckman and Turnbull models were employed to estimate WTP-Q. Difference in estimated values between scenarios was assessed using the Kruskal-Wallis test.
RESULTS: Data from 3,751 participants were used for analysis. The estimated WTP-Q based on the scenarios showed a statistically significant difference (P < 0.05), with WTP per QALY higher in the scenario with a shorter time horizon (the final stages of life) compared to those with longer time horizons (10 and 20 years). The mean (median) CETs using the Heckman model were: CA $120,569 (CA $112,724) for the final stages of life, CA $113,334 (CA $95,309) for the 10-year horizon, and CA $108,581 (CA $93,640) for the 20-year horizon, with an overall value of CA $110,353 (CA $95,573) across all scenarios. For Turnbull model, the CETs were: CA $171,640 (CA$ 30,000) for the final stages of life, CA$108,681 (CA$ 5,000) for the 10-year horizon, and CA $100,746 (CA$ 5,000) for the 20-year horizon, with an overall value of CA$121,556 (CA$10,000). Age, gender, EuroQol 5-Dimension visual analog scale (VAS), income, and the number of children significantly impacted WTP-Q.
CONCLUSIONS: CETs estimated for the whole scenarios were 2.11 and 2.33 times the gross domestic product (GDP) per capita in 2019 for the Heckman and Turnbull models, respectively. These CETs fall within the WHO's recommended range of 1 to 3 times GDP per capita, remaining below the upper limit of 3, which is considered the highest threshold for cost-effectiveness.