OBJECTIVES: For the last 10 years health economic assessment in France focuses on a QALY-based cost-effectiveness analysis. Defining a Willingness-To-Pay (WTP) for a QALY (WTP-Q) is not an easy task and is related to the lack of consensus on the use of a reference value for economic evaluation in France. A recent study estimated the Value of Statistical QALY (VSQ) between €147,093 and €200,398. VSQ was derived from Value of Statistical Life (VSQ), a standard metric associated to the WTP for saving a life or reducing a fatal risk. It is considered that VSQ reflects much more WTP for lifetime gain rather than health improvement and consequently over-estimates WTP-Q. We used a recently published theoretical framework to estimate WTP-Q for France.

METHODS: We estimated a WTP-Q(a) for a given age a that reflects both the WTP for health improvement and lifetime gain. WTP-Q(a) is modelled from VSQ(a), imminent and long-term death risk, minimum and maximum expected quality of life over an age-dependent life expectancy, and risk aversion for future scenario including both probability of good health and highly deteriorated health. We applied the recommended discount rate by the French Committee of Economic and Public Health Evaluation (CEESP). Finally, consistently with the method applied to estimate one unique VSQ, we estimated one unique WTP-Q as weighted average of WTP-Q(a) according to the demographic structure of the French population.

RESULTS: According to individual risk aversion ranging from full aversion to neutral posture, we estimated a WTP-Q ranged between €27,847 and €112,586.

CONCLUSIONS: Assuming VSQ incompletely reflects WTP-Q, it was possible to estimate lower and upper bound of WTP-Q. If there is still to be discussed to define the acceptable level of risk aversion, we hope our contribution will help going forward to define a reference value for health economic evaluation in France.