Establishing Robust and Adaptive Willingness-to-Pay Thresholds for Taiwan's National Health Insurance: A Case Study of Non-Small Cell Lung Cancer
Author(s)
HSIN-HSUAN WANG, BS1, CHEN-YI YANG, MS1, Huang-tz Ou, PhD2.
1Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, 2Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
1Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, 2Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
OBJECTIVES: To establish robust willingness-to-pay (WTP) thresholds from the perspective of Taiwan’s National Health Insurance Administration (NHIA) using advanced modelling approaches illustrated by real-world cases of non-small cell lung cancer (NSCLC).
METHODS: We employed a two-step modeling approach utilizing data from the National Health Insurance Research database (2013-2022) and comprehensive literature reviews. First, regression analyses were conducted with healthcare costs as the independent variable and life-years (LYs)/quality-adjusted life-years (QALYs) as dependent variables. Second, elasticity coefficients derived from these regressions were used to estimate the WTP thresholds. Scenario analyses were performed, adjusting for key covariates (e.g., demographics, cancer stages, treatment types, and comorbidities) and instrumental variables (IVs) to control for potential confounding and endogeneity issues. Additionally, a subgroup analysis of metastatic NSCLC patients from 2019-2022 was conducted to examine WTP thresholds relevant to reimbursement decisions for novel therapies. Costs were standardized and reported in 2022 US dollars.
RESULTS: The base-case analysis of 118,698 patients estimated WTP thresholds at $27,958 (0.85 times Taiwan’s per-capita gross domestic product [GDP]); 95% CI: $27,721-28,199) per LY gained and $35,643 (1.09 times Taiwan per-capita GDP; 95% CI: $35,317-35,974) per QALY gained. When separately adjusting for covariates, instrumental variables (IVs), and both covariates and IVs, the LY-based thresholds decreased to $17,910 (0.55 times per-capita GDP), $9,163 (0.28 times per-capita GDP), and $10,355 (0.32 times per-capita GDP), respectively. Within the novel therapy reimbursement scenario for metastatic NSCLC, the thresholds notably changed by 1.2-fold (e.g., $33,560 per LY gained) compared to the base-case WTP thresholds.
CONCLUSIONS: We demonstrated a practical modeling framework to derive robust and adaptable WTP thresholds relevant to universal healthcare settings, exemplified through NSCLC. Incorporating various clinical and policy scenarios along with routine updating ensures broader applicability and improves decision-making processes for reimbursement.
METHODS: We employed a two-step modeling approach utilizing data from the National Health Insurance Research database (2013-2022) and comprehensive literature reviews. First, regression analyses were conducted with healthcare costs as the independent variable and life-years (LYs)/quality-adjusted life-years (QALYs) as dependent variables. Second, elasticity coefficients derived from these regressions were used to estimate the WTP thresholds. Scenario analyses were performed, adjusting for key covariates (e.g., demographics, cancer stages, treatment types, and comorbidities) and instrumental variables (IVs) to control for potential confounding and endogeneity issues. Additionally, a subgroup analysis of metastatic NSCLC patients from 2019-2022 was conducted to examine WTP thresholds relevant to reimbursement decisions for novel therapies. Costs were standardized and reported in 2022 US dollars.
RESULTS: The base-case analysis of 118,698 patients estimated WTP thresholds at $27,958 (0.85 times Taiwan’s per-capita gross domestic product [GDP]); 95% CI: $27,721-28,199) per LY gained and $35,643 (1.09 times Taiwan per-capita GDP; 95% CI: $35,317-35,974) per QALY gained. When separately adjusting for covariates, instrumental variables (IVs), and both covariates and IVs, the LY-based thresholds decreased to $17,910 (0.55 times per-capita GDP), $9,163 (0.28 times per-capita GDP), and $10,355 (0.32 times per-capita GDP), respectively. Within the novel therapy reimbursement scenario for metastatic NSCLC, the thresholds notably changed by 1.2-fold (e.g., $33,560 per LY gained) compared to the base-case WTP thresholds.
CONCLUSIONS: We demonstrated a practical modeling framework to derive robust and adaptable WTP thresholds relevant to universal healthcare settings, exemplified through NSCLC. Incorporating various clinical and policy scenarios along with routine updating ensures broader applicability and improves decision-making processes for reimbursement.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE415
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Thresholds & Opportunity Cost
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology