Estimating the range of incremental cost-effectiveness thresholds for healthcare based on willingness to pay and GDP per capita: A systematic review

• Published in: PloS one Vol. 17; no. 4; p. e0266934
• Main Authors: Iino, Haru, Hashiguchi, Masayuki, Hori, Satoko
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.04.2022; Public Library of Science (PLoS)
• Subjects: Benefit cost analysis; Biology and Life Sciences; Correlation; Cost assessments; Cost benefit analysis; Decision making; Delivery of Health Care; Economic aspects; Evaluation; GDP; Gross Domestic Product; Health care; Health policy; Humans; Informatics; Life expectancy; Life span; Medical care, Cost of; Medicine and Health Sciences; Opportunity costs; Outliers (statistics); People and Places; Per capita; Pharmacy; Population; Purchasing power parity; Quality-Adjusted Life Years; Reimbursement; Social Sciences; Statistical analysis; Surveys and Questionnaires; Taiwan; University faculty; Willingness to pay; Taiwan; Thailand; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0266934

Decision-making in healthcare policy involves assessing both costs and benefits. In determining the cost-effectiveness (CE) threshold, willingness to pay (WTP) per quality-adjusted life year (QALY), GDP per capita, and other factors are important. However, the relationship between WTP/QALY or GDP per capita and the CE threshold is unclear. It is important to clarify the relationship between WTP/QALY and GDP to provide a clear basis for setting the CE threshold. The purpose of this study was to compare WTP/QALY and GDP per capita, and to develop a new CE threshold range based on WTP using GDP per capita. The relationship between WTP/QALY and healthy life expectancy (HALE) was also investigated. We searched MEDLINE, EMBASE and Web of Science from 1980/01/01 to 2020/12/31 using the following selection criteria (latest search: Dec 2021):1, studies that estimated WTP/QALY; 2, the general population was surveyed; 3, the article was in English. From the collected articles, we obtained average values of WTP/QALY for various countries and compared WTP/QALY with GDP per capita. The correlation between WTP/QALY and HALE was also examined. We identified 20 papers from 17 countries. Comparison of mean WTP/QALY values with GDP per capita showed that most WTP/QALY values were in the range of 0.5-1.5 times GDP per capita, though the median values were less than 0.5 times. Comparison of WTP/QALY with HALE showed a statistically significant positive correlation when Taiwan was excluded as an outlier. Our results suggest a CE threshold range of 0.5-1.5 times GDP per capita is appropriate but lower than the WHO-recommended range of 1-3 times. The correlation between WTP/QALY and HALE suggests that investment in healthcare is reflected in an increased healthy life expectancy. Since WTP is based on consumer preferences, this range could be used to set a generally acceptable criterion.