Moradi Najmeh, Rashidian Arash, Rasekh Hamid Reza, Olyaeemanesh Alireza, Foroughi Mahnoosh, Mohammadi Teymoor
School of Pharmacy ,Shahid Beheshti University of medical sciences, Tehran, Iran.
School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Pharm Res. 2017 Spring;16(2):823-833.
The aim of this study was to estimate the monetary value of a QALY among patients with heart disease and to identify its determinants. A cross-sectional survey was conducted through face-to-face interview on 196 patients with cardiovascular disease from two heart hospitals in Tehran, Iran, to estimate the value of QALY using disaggregated and aggregated approaches. The EuroQol-5 Dimension (EQ-5D) questionnaire, Visual Analogue Scale (VAS), Time Trade-Off (TTO) and contingent valuation WTP techniques were employed, first to elicit patients' preferences and then, to estimate WTP for QALY. The association of patients' characteristics with WTP for QALY, was assessed through Heckman selection model. The Mean willingness to pay per QALY, estimated by the disaggregated approach ranged from 2,799 to 3599 US dollars. It is higher than the values, estimated from aggregated methods (USD 2,256 to 3,137). However, in both approaches, the values were less than one Gross Domestic Product (GDP) per capita of Iran. Significant variables were: Current health state, education, age, marital status, number of comorbidities, and household's cost group. Our results challenge two major issues: the first, is a policy challenge which concerns the WHO recommendation to use less than 3 GDP per capita as a cost-effectiveness threshold value. The second, is an analytical challenge related to patients with zero QALY gain. More scrutiny is suggested on the issue of how patients with full health state valuation should be dealt with and what arbitrary value could be included in the estimation value of QALY when the disaggregated approach used.
本研究的目的是估计心脏病患者中质量调整生命年（QALY）的货币价值，并确定其决定因素。通过对伊朗德黑兰两家心脏病医院的196名心血管疾病患者进行面对面访谈，开展了一项横断面调查，以使用分解法和综合法估计QALY的价值。采用了欧洲五维健康量表（EQ-5D）问卷、视觉模拟量表（VAS）、时间权衡法（TTO）和条件估值支付意愿（WTP）技术，首先引出患者的偏好，然后估计QALY的WTP。通过Heckman选择模型评估患者特征与QALY的WTP之间的关联。用分解法估计的每QALY平均支付意愿为2799至3599美元。该值高于用综合法估计的值（2256至3137美元）。然而，在两种方法中，这些值均低于伊朗人均国内生产总值（GDP）。显著变量包括：当前健康状况、教育程度、年龄、婚姻状况、合并症数量和家庭成本组。我们的研究结果对两个主要问题提出了挑战：第一，是一个政策挑战，涉及世界卫生组织建议将人均GDP的3倍以下作为成本效益阈值。第二，是一个与QALY增益为零的患者相关的分析挑战。建议对如何处理完全健康状态估值的患者以及在使用分解法时QALY估计值中可纳入何种任意值的问题进行更多审查。
