Moradi Najme, Rashidian Arash, Nosratnejad Shirin, Olyaeemanesh Alireza, Zanganeh Marzieh, Zarei Leila
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Pharmacoecon Open. 2019 Sep;3(3):311-319. doi: 10.1007/s41669-018-0111-2.
A limited number of studies have specifically examined the value of quality-adjusted life-years (QALYs) from the patient's perspective.
The goal of this study was to investigate the worth of QALYs from the perspectives of patients with diabetes using health and willingness-to-pay (WTP) measures.
A hypothetical treatment characterized by a permanent cure was presented to 149 patients with diabetes in Tehran, Iran, to elicit the monetary value that they attach to QALYs. The QALY gains of the participants were determined using the EuroQol-5 Dimensions, 3 Levels instrument, the visual analogue scale, and the time trade-off method. A mixed closed-ended WTP model supported by an open-ended question was used to ascertain the monetary value of a QALY gained. Finally, we used each respondent's ratio of WTP to QALY gained and the mean of the ratios to estimate the worth of a QALY to all respondents.
In total, 96% of respondents were willing to pay out of pocket for the restoration of full health, whereas 4% exhibited a zero WTP because of an inability to pay. The mean WTP per QALY varied depending on the health measure and discount rate used, ranging from $US1191 to $US5043 in sensitivity analysis, which is equal to 0.23-0.95 of Iran's gross domestic product (GDP) per capita in 2015.
Applying the upper limit of the World Health Organization's (WHO) cost-effectiveness threshold (i.e., three times the local GDP per capita) in resource allocation decisions requires caution and investigation, particularly in low- and middle-income countries with limited healthcare resources. To generalize our findings, especially for application to decision making, additional surveys involving more representative samples from different settings are recommended.
仅有少数研究专门从患者角度考察了质量调整生命年（QALYs）的价值。
本研究的目的是使用健康和支付意愿（WTP）测量方法，从糖尿病患者的角度调查QALYs的价值。
向伊朗德黑兰的149名糖尿病患者介绍了一种以永久治愈为特征的假设治疗方法，以引出他们赋予QALYs的货币价值。使用欧洲五维健康量表（EuroQol-5 Dimensions, 3 Levels instrument）、视觉模拟量表和时间权衡法确定参与者的QALY增益。采用由开放式问题支持的混合封闭式WTP模型来确定获得的一个QALY的货币价值。最后，我们使用每个受访者的WTP与获得的QALY的比率以及这些比率的平均值来估计对所有受访者而言一个QALY的价值。
总体而言，96%的受访者愿意自掏腰包支付以恢复完全健康，而4%的受访者因无力支付而表现出零支付意愿。每个QALY的平均支付意愿因所使用的健康测量方法和贴现率而异，在敏感性分析中范围为1191美元至5043美元，这相当于2015年伊朗人均国内生产总值（GDP）的0.23 - 0.95。
在资源分配决策中应用世界卫生组织（WHO）成本效益阈值的上限（即当地人均GDP的三倍）需要谨慎和调查，特别是在医疗资源有限的低收入和中等收入国家。为了推广我们的研究结果，特别是用于决策，建议进行更多涉及来自不同背景更具代表性样本的额外调查。
