Economic Valuation of Health Gains in Pakistan: Estimating Willingness to Pay for One Quality-Adjusted Life Year (QALY)
Author(s)
Faizur Rehman, PharmD, RPh1, Muhammad Wasay Shahid, PharmD, RPh2, Mehran Riaz, PharmD, RPh1, Farah Azhar, PharmD, MPhil, PhD1, Malik Muhammad Umair, MBBS3, Muhammad Amer, PharmD, MPhil, PhD4, Ali Ahmed, MPhil, PharmD, PhD5.
1Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan, 2Riphah International University, Islamabad, Pakistan, 3National AIDS Control Program, Common Management Unit, Islamabad, Pakistan, 4Department of Pharmacy, Abasyn University, Islamabad, Pakistan, 5University of California San Diego, San Diego, CA, USA.
1Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan, 2Riphah International University, Islamabad, Pakistan, 3National AIDS Control Program, Common Management Unit, Islamabad, Pakistan, 4Department of Pharmacy, Abasyn University, Islamabad, Pakistan, 5University of California San Diego, San Diego, CA, USA.
OBJECTIVES: Healthcare resource allocation in low- and middle-income countries (LMICs) like Pakistan is often constrained by economic limitations and inequitable distribution. Cost Effectiveness Analysis (CEA), using Quality Adjusted Life Years (QALYs) serves as a vital tool in evidence-based decision-making. The World Health Organization (WHO) recommends that if certain cost falls below 2-3 times GDP per capita it is cost-effective. This recommendation lacks practically derived evidence since WTP for one QALY (WTP/QALY) seldomly crosses 1 times GDP per capita. Similarly, 2-3 times the GDP per QALY may strain the national budget. This study sought to assess WTP/QALY among general population of Pakistan thus informing country-specific cost effectiveness thresholds.
METHODS: A cross-sectional study was conducted on 600 participants from March till October 2024 using a contingent valuation method with payment card approach. Participants were recruited through convenient sampling technique. Health-related quality of life was assessed using EuroQoL Five Dimensions, Five Levels (EQ-5D-5L) tool, and the Visual Analog Scale (VAS). Determinants of WTP/Q were analysed by two-part regression model.
RESULTS: Mean WTP/Q was found to be 114,006.4 Pakistani Rupee (PKR) (USD 410.11) i.e. 0.29 times the national GP per capita. It underscores the great societal value for life-extending scenarios over quality-of-life (QoL) improvements, with preferences. Higher education, income, and higher treatment success significantly increased WTP while gender, region and mental health also shaped preferences. Interestingly, certainty increased WTP for QoL gains contradicting prospect theory while life-extending preferences aligned with it.
CONCLUSIONS: This study provides first empirical evidence of WTP per QALY in Pakistan. The WTP values challenge the applicability of WHO’s recommended thresholds thus advocating establishment of localized cost-effectiveness benchmarks. These nuanced insights support the need implementing tiered pricing and instutionalize health technology assessment (HTA) for equitable and sustainable healthcare decision making.
METHODS: A cross-sectional study was conducted on 600 participants from March till October 2024 using a contingent valuation method with payment card approach. Participants were recruited through convenient sampling technique. Health-related quality of life was assessed using EuroQoL Five Dimensions, Five Levels (EQ-5D-5L) tool, and the Visual Analog Scale (VAS). Determinants of WTP/Q were analysed by two-part regression model.
RESULTS: Mean WTP/Q was found to be 114,006.4 Pakistani Rupee (PKR) (USD 410.11) i.e. 0.29 times the national GP per capita. It underscores the great societal value for life-extending scenarios over quality-of-life (QoL) improvements, with preferences. Higher education, income, and higher treatment success significantly increased WTP while gender, region and mental health also shaped preferences. Interestingly, certainty increased WTP for QoL gains contradicting prospect theory while life-extending preferences aligned with it.
CONCLUSIONS: This study provides first empirical evidence of WTP per QALY in Pakistan. The WTP values challenge the applicability of WHO’s recommended thresholds thus advocating establishment of localized cost-effectiveness benchmarks. These nuanced insights support the need implementing tiered pricing and instutionalize health technology assessment (HTA) for equitable and sustainable healthcare decision making.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA121
Topic
Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Systems & Structure
Disease
No Additional Disease & Conditions/Specialized Treatment Areas