Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation

• Published in: Medical decision making Vol. 25; no. 6; p. 667
• Main Authors: King, Jr, Joseph T, Tsevat, Joel, Lave, Judith R, Roberts, Mark S
• Format: Journal Article
• Language: English
• Published: United States 01.11.2005
• Subjects: Adult; Aged; Female; Financing, Personal; Health Care Rationing; Humans; Male; Middle Aged; Quality-Adjusted Life Years
• ISSN: 0272-989X
• DOI: 10.1177/0272989x05282640

Health-state preferences can be combined with willingness-to-pay (WTP) data to calculate WTP per quality-adjusted life year (QALY). The WTP/QALY ratios provide insight into societal valuations of expenditures for medical interventions. The authors measured preferences for current health in 3 patient populations (N = 391) using standard gamble, time trade-off, visual analog scale, and WTP, then they calculated WTP/QALY ratios. The ratios were compared with several proposed cost/QALY cost-effectiveness ratio thresholds, the value-of-life literature, and with WTP/QALY ratios derived from published preference research. Mean WTP/QALY ratios ranged from 12,500 to 32,200 US dollars (2003 US dollars). All values were below most published cost-effectiveness ratio thresholds, below the ratio from a prototypic medical treatment covered by Medicare (i.e., renal dialysis), and below ratios from the value-of-life literature. The WTP/QALY ratios were similar to those calculated from published preference data for patients with symptomatic meno-pause, dentofacial deformities, asthma, or dermatologic disorders. WTP/QALY ratios calculated using preference data collected from diverse populations are lower than most proposed thresholds for determining what is "cost-effective." Current proposed cost-effectiveness ratio thresholds may overestimate the willingness of society to pay for medical interventions.