OBJECTIVES: Our objective was to investigate the monetary worth of health improvements at the end of a patient's life, specifically the value of a life year (VOLY) gained, in Croatia. We aimed to determine if the nature of the illness being assessed (cancer or rare disease) influences the valuation of end-of-life VOLYs. The outcomes of our study aim to contribute to the existing literature on health and longevity valuation, particularly regarding the appropriate cost-effectiveness threshold for end-of-life treatments. Additionally, we aim to provide insight into the ongoing debate on whether a premium should be justified for cancer and/or rare disease therapies.

METHODS: To calculate the willingness to pay for gains in remaining life expectancy at the end of life, we employed the contingent valuation method. Our assessment considered the social-inclusive-individual perspective and utilized payment scales and open-ended payment vehicles. This approach simulated the real-world decision-making process of determining whether to reimburse therapies targeted at end-of-life conditions, such as metastatic cancer, which primarily focus on life extension rather than improving quality of life.

RESULTS: The average value of an end-of-life VOLY across all scenarios was estimated at €67,000 (with a median of €40,000). In scenarios where respondents were offered a full year of life extension, the estimated value of an end-of-life VOLY was €33,000 (with a median of €22,000). Our findings indicate that the specific type of illness afflicting the patient does not influence evaluations of end-of-life VOLY.

CONCLUSIONS: If a treatment does not improve the quality of a patient's life, we can argue that cost-effectiveness analyses utilizing life years gained (LYG) could provide valuable information to policymakers and potentially justify their own cost-effectiveness threshold.