OBJECTIVES : Health economic analyses (HEAs) are typically performed by comparing health benefits and costs of an intervention to those of one or more alternatives, e.g. the standard of care for a specific disease). The probability of cost-effectiveness (CE), an HEA outcome, is positioned against a governing willingness-to-pay threshold (WTPt). While WTPt is well-defined in health technology assessment–focused health systems, understanding the value for money of health interventions is hindered where formal WTPts are not established. In such settings, the World Health Organization (WHO) guidance is often followed to determine CE. Our study aimed to identify the WTPt used in daily practice in China for interventions in oncology.

METHODS : A targeted search was conducted in English and Chinese languages to identify research articles reporting on WTPt in literature databases (Medline, Embase, and CNKI) and conference proceedings (ASCO, CSCO, ESMO, and ISPOR) published during the last 5 years. A total of 599 hits were found; after deduplication, 503 articles underwent full-text review. If full text was available, abstract-only screening was skipped, as the abstract was not expected to address WTPt.

RESULTS : After full-text screening, 31 additional duplicates and 308 studies were excluded (not Chinese [n=64], not oncology [n=211], no WTPt [n=28], other reasons [n=5]). Incremental CE ratios were reported in 163 of 164 publications, in 23 distinct indications. A WTPt at 3× gross domestic product per capita (GDPc) was applied most frequently, explicitly or implicitly (n=131 [80%] and n=16 [10%]), followed by a WTPt of 1× GDPc (n=9 [5%] and n=2 [1%]). Of the studies using a WTPt of 3× GDPc, 90 (69%) referenced the WHO guidance directly, and 13 (10%) referenced the guidance indirectly through the China Guidelines for Pharmacoeconomic Evaluations.

CONCLUSIONS : Our research suggests that in China, 3x GDPc is the preferential WTPt for health interventions in oncology.