van de Wetering Liesbet, van Exel Job, Bobinac Ana, Brouwer Werner B F
Institute of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, The Netherlands.
Pharmacoeconomics. 2015 Dec;33(12):1289-300. doi: 10.1007/s40273-015-0311-x.
To judge whether an intervention offers value for money, the incremental costs per gained quality-adjusted life-year (QALY) need to be compared with some relevant threshold, which ideally reflects the monetary value of health gains. Literature suggests that this value may depend on the equity context in which health gains are produced, but the value of a QALY in relation to equity considerations has remained largely unexplored.
The objective of this study was to estimate the social marginal willingness to pay (MWTP) for QALY gains in different equity subgroups, using a discrete choice experiment (DCE). Both severity of illness (operationalized as proportional shortfall) and fair innings (operationalized as age) were considered as grounds for differentiating the value of health gains.
We obtained a sample of 1205 respondents, representative of the adult population of the Netherlands. The data was analysed using panel mixed multinomial logit (MMNL) and latent class models.
The panel MMNL models showed counterintuitive results, with more severe health states reducing the probability of receiving treatment. The latent class models revealed distinct preference patterns in the data. MWTP per QALY was sensitive to severity of disease among a substantial proportion of the public, but not to the age of care recipients.
These findings emphasize the importance of accounting for preference heterogeneity among the public on value-laden issues such as prioritizing health care, both in research and decision making. This study emphasises the need to further explore the monetary value of a QALY in relation to equity considerations.
为判断一项干预措施是否具有成本效益，需要将每获得一个质量调整生命年（QALY）的增量成本与某个相关阈值进行比较，该阈值理想情况下反映了健康收益的货币价值。文献表明，这一价值可能取决于产生健康收益的公平背景，但QALY相对于公平考虑因素的价值在很大程度上仍未得到探索。
本研究的目的是使用离散选择实验（DCE）估计不同公平亚组中QALY增益的社会边际支付意愿（MWTP）。疾病严重程度（以比例缺口衡量）和公平寿龄（以年龄衡量）均被视为区分健康收益价值的依据。
我们获得了1205名受访者的样本，该样本代表荷兰成年人口。使用面板混合多项logit（MMNL）模型和潜在类别模型对数据进行分析。
面板MMNL模型显示出与直觉相反的结果，即健康状况越严重，接受治疗的概率越低。潜在类别模型揭示了数据中不同的偏好模式。相当一部分公众中，每QALY的MWTP对疾病严重程度敏感，但对接受护理者的年龄不敏感。
这些发现强调了在研究和决策中考虑公众在诸如医疗保健优先排序等充满价值问题上的偏好异质性的重要性。本研究强调需要进一步探索QALY相对于公平考虑因素的货币价值。
