Safari Hossein, Poder Thomas G, Afshari Somayeh, Nahvijou Azin, Arab-Zozani Morteza, Moradi Nasrin, Ameri Hosein
Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran.
Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada.
Front Oncol. 2022 Dec 12;12:1039589. doi: 10.3389/fonc.2022.1039589. eCollection 2022.
The estimation of a cost- Effectiveness (CE) threshold from the perspective of those who have experienced a life-threatening disease can provide empirical evidence for health policy makers to make the best allocation decisions on limited resources. The aim of the current study was to empirically determine the CE threshold for cancer interventions from the perspective of cancer patients in Iran.
A composite time trade-off (cTTO) task for deriving quality adjusted life-year (QALY) and a double-bounded dichotomous choice (DBDC) approach followed by open-ended question for examining patients' willingness-to-pay were performed. A nationally representative sample of 580 cancer patients was recruited from the largest governmental cancer centers in Iran between June 2021 and January 2022, and data were gathered using face-to-face interviews. The CE threshold was calculated using the nonparametric Turnbull model and parametric interval-censored Weibull regression model. Furthermore, the factors that affect the CE threshold were determined using the parametric model.
The estimated CE threshold using the nonparametric Turnbull model and parametric interval-censored Weibull regression model was IRR 440,410,000 (USD 10,485.95) and IRR 595,280,000 (USD 14,173.33) per QALY, respectively. Gender, age, education, income, type of cancer, and current treatment status were significantly associated with the estimated CE threshold.
The value of parametric model-based threshold in this study was 1.98 times the Iranian GDP per capita, which was lower than the CE threshold value recommended by the WHO (i.e., 3 times the GDP per capita) for low-and middle-income countries.
从经历过危及生命疾病的人群角度估算成本效益（CE）阈值，可为卫生政策制定者在有限资源上做出最佳分配决策提供实证依据。本研究的目的是从伊朗癌症患者的角度实证确定癌症干预措施的CE阈值。
采用用于推导质量调整生命年（QALY）的复合时间权衡（cTTO）任务以及双边界二分选择（DBDC）方法，随后通过开放式问题考察患者的支付意愿。2021年6月至2022年1月期间，从伊朗最大的政府癌症中心招募了580名具有全国代表性的癌症患者样本，并通过面对面访谈收集数据。使用非参数特恩布尔模型和参数区间删失威布尔回归模型计算CE阈值。此外，使用参数模型确定影响CE阈值的因素。
使用非参数特恩布尔模型和参数区间删失威布尔回归模型估计的CE阈值分别为每QALY 440,410,000伊朗里亚尔（10,485.95美元）和595,280,000伊朗里亚尔（14,173.33美元）。性别、年龄、教育程度、收入、癌症类型和当前治疗状态与估计的CE阈值显著相关。
本研究中基于参数模型的阈值价值是伊朗人均GDP的1.98倍，低于世界卫生组织为低收入和中等收入国家推荐的CE阈值（即人均GDP的3倍）。
