College of Business Administration, Shenyang Pharmaceutical University, Shenyang, 110016, China.
School of Public Administration, Hainan University, Hainan, China.
Appl Health Econ Health Policy. 2022 Nov;20(6):893-904. doi: 10.1007/s40258-022-00750-z. Epub 2022 Aug 8.
The aim of this study was to estimate the population's willingness to pay (WTP) for an additional quality-adjusted life-year (QALY) in China.
The WTP for an additional QALY (WTP/Q) was estimated using a contingent valuation survey with quota sampling and snowball sampling, using a pre-designed questionnaire with 18 hypothetical scenarios. The change in health state was depicted by the EQ-5D-5L. The questionnaires were completed by telephone and face-to-face interviews. Two-part regression models were used to test validity and how different factors affect WTP/Q.
A total of 2008 people participated in this survey and provided 3265 WTP responses for further analysis. The average WTP/Q for the entire sample is 113,120 Renminbi (RMB) (USD 16,884), which is 1.75 times the gross domestic product (GDP) per capita. For the quality-of-life improvement scenarios, the mean WTP/Q is RMB 78,907 (USD 11,777, 1.22 times GDP per capita), which is significantly lower than the life extension scenarios (RMB 177,761, USD 26,531, 2.76 times GDP per capita). Age was found to be negatively related to positive WTP. Educational level was positively related to the probability of reporting positive WTP and the level of WTP/Q. Although the EQ-5D-5L utility scores of respondents did not prove to be statistically significant determinants of WTP/Q, the two dimensions of EQ-5D-5L, pain/discomfort and anxiety/depression, had an impact on WTP/Q. In addition, WTP/Q was higher when the health outcome had a 50% probability of occurring than when the health outcome was 100% certain. WTP/Q was higher when a lower health gain was presented to the respondent.
This study provides empirical evidence of the monetary value of an additional QALY from a sample of the Chinese population. In addition, a higher threshold for end-of-life therapies should be considered.
本研究旨在估算中国民众对额外质量调整生命年（QALY）的支付意愿（WTP）。
采用条件价值评估调查，采用配额抽样和雪球抽样，使用预先设计的问卷和 18 个假设情景，估计 WTP/QALY。健康状态的变化通过 EQ-5D-5L 描述。问卷调查通过电话和面对面访谈完成。使用两部分回归模型检验有效性和不同因素对 WTP/Q 的影响。
共有 2008 人参与了这项调查，并提供了 3265 个 WTP 回复，用于进一步分析。整个样本的平均 WTP/Q 为 113120 元人民币（16884 美元），是人均国内生产总值（GDP）的 1.75 倍。对于生活质量改善的情景，平均 WTP/Q 为 78907 元人民币（11777 美元，是人均 GDP 的 1.22 倍），明显低于延长生命的情景（177761 元人民币，26531 美元，是人均 GDP 的 2.76 倍）。年龄与正向 WTP 呈负相关。教育水平与报告正向 WTP 的概率和 WTP/Q 水平呈正相关。尽管受访者的 EQ-5D-5L 效用评分未被证明是 WTP/Q 的统计学显著决定因素，但 EQ-5D-5L 的两个维度，疼痛/不适和焦虑/抑郁，对 WTP/Q 有影响。此外，当健康结果发生的概率为 50%时，WTP/Q 高于 100%确定时。当向受访者呈现较低的健康收益时，WTP/Q 更高。
本研究从中国人群样本中提供了额外 QALY 的货币价值的经验证据。此外，应该考虑对生命末期治疗的更高门槛。
