WHAT IS POLITICIAN'S AND CLINICIAN'S WILLINGNESS TO PAY (WTP) FOR FUTURE HEALTH BENEFIT BASED ON 15D, EQ-5D AND LIFE-YEARS? A CONTINGENT VALUATION (CV) AMONG 8 DISEASES WITH THE TOTAL OF 1092 CASES
Author(s)
Erkki J Soini, MSc(HE), RN, CEO1, Jarmo Kukkonen, PhD, MD, Clinician2, Markku Myllykangas, PhD, Senior Assistant3, Olli-Pekka Ryynänen, Phd, MD, Professor, docent41ESiOR Oy, Department of Health Policy and Management, and Department of Social Pharmacy, University of Kuopio, Kuopio, Finland; 2 Kuntohovi Spa, Joensuu, Finland; 3 University of Kuopio, Kuopio, Finland; 4 University of Kuopio and Kuopio University Hospital, Kuopio, Finland
OBJECTIVES: To estimate WTP (€, 2006 value) per incremental quality-adjusted life-year (QALY) gained for a future health technology when compared to the current technology in the treatment of a particular disease. Secondly, WTP for incremental life-year gained (LYG), and WTP for average QALY and LY were estimated. METHODS: For the first time in the Finnish setting, CV was used to establish WTP for health benefits that do not have market prices. A postal survey including 8 diseases (1092 cases in total) with dichotomous choice (DC) type questions was carried out to clinicians (N 197) and political decision makers (N 225). Based on the answers with varying costs for health benefit, aggregate demand functions (ADF) were drawn and the mean WTP for particular benefit in particular disease was estimated as the area under ADF. As a new innovation, the potential future order of disease priority in terms of WTP was established by estimating cumulative marginal changes (CMC) in ADF. The care costs and utilities were obtained from recent Finnish literature. Discounting with 5% and 0% was done due to the life-time perspectives. RESULTS: The mean WTP per incremental QALY gained with 15D/EQ-5D utilities were the following (CMCs are in the parentheses): neurological disturbance €420,921/46,8004 (€147,653/164,168), metabolic disturbance €320,974/333,961 (€118,823/123,631), cancer €127,937/138,308 (€61,611/66,604), dementia €100,536/107,731 (€40,830/43,731), paraplegia €124,544/563,41 (€35,013/15,839), coronary heart disease €48,381/50,928 (€15,191/15,989), type 1 diabetes €107,114/548,63 (€19,989/10,238), and narcomaniac €30,859/45,106 (€7,705/14,231). WTPs for incremental LYG, average QALY and LY were lower. The difference between EQ-5D and 15D WTP exceeded 10% in paraplegia, diabetes, narcomaniacs, and neurological disease. This demonstrated that the results obtained using different utility tools differ even in the ADF-setting. CONCLUSIONS: Depending on the disease and utility tool, CV based on DCs seems to result to different ADFs and WTPs. By estimating CMCs from ADFs, potential future order for diseases is estimated.
Conference/Value in Health Info
2008-11, ISPOR Europe 2008, Athens, Greece
Value in Health, Vol. 11, No. 6 (November 2008)
Code
PMC23
Topic
Methodological & Statistical Research
Topic Subcategory
PRO & Related Methods
Disease
Multiple Diseases