Peng Qian, Yin Yue, Liang Min, Zhao Mingye, Shao Taihang, Tang Yaqian, Mei Zhiqing, Li Hao, Tang Wenxi
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Cost Eff Resour Alloc. 2023 Nov 2;21(1):80. doi: 10.1186/s12962-023-00487-z.
Monetizing health has sparked controversy and has implications for pricing strategies of emerging health technologies. Medical insurance payers typically set up thresholds for quality-adjusted life years (QALY) gains based on health productivity and budget affordability, but they rarely consider patient willingness-to-pay (WTP). Our study aims to compare Chinese payer threshold and patient WTP toward QALY gain of advanced non-small cell lung cancer (NSCLC) and to inform a potential inclusion of patient WTP under more complex decision-making scenarios.
A regression model was constructed with cost as the independent variable and QALY as the dependent variable, where the regression coefficients reflect mean opportunity cost, and by transforming these coefficients, the payer threshold can be obtained. Patient WTP was elicited through a contingent valuation method survey. The robustness of the findings was examined through sensitivity analyses of model parameters and patient heterogeneity.
The payer mean threshold in the base-case was estimated at 150,962 yuan (1.86 times per capita GDP, 95% CI 144,041-159,204). The two scenarios analysis generated by different utility inputs yielded thresholds of 112,324 yuan (1.39 times per capita GDP) and 111,824 yuan (1.38 times per capita GDP), respectively. The survey included 85 patients, with a mean WTP of 148,443 yuan (1.83 times per capita GDP, 95% CI 120,994-175,893) and median value was 106,667 yuan (1.32 times the GDP per capita). Due to the substantial degree of dispersion, the median was more representative. The payer threshold was found to have a high probability (98.5%) of falling within the range of 1-2 times per capita GDP, while the robustness of patient WTP was relatively weak.
In China, a country with a copayment system, payer threshold was higher than patient WTP, indicating that medical insurance holds significant decision-making authority, thus temporarily negating the need to consider patient WTP.
将健康货币化引发了争议，并对新兴健康技术的定价策略产生影响。医疗保险支付方通常根据健康生产力和预算承受能力为质量调整生命年（QALY）收益设定阈值，但很少考虑患者的支付意愿（WTP）。我们的研究旨在比较中国支付方对晚期非小细胞肺癌（NSCLC）QALY收益的阈值与患者的WTP，并为在更复杂决策场景下潜在纳入患者WTP提供参考。
构建以成本为自变量、QALY为因变量的回归模型，其中回归系数反映平均机会成本，通过转换这些系数可获得支付方阈值。通过条件估值法调查得出患者的WTP。通过对模型参数和患者异质性的敏感性分析来检验研究结果的稳健性。
基础案例中支付方的平均阈值估计为150,962元（人均GDP的1.86倍，95%可信区间144,041 - 159,204）。由不同效用输入产生的两种情景分析得出的阈值分别为112,324元（人均GDP的1.39倍）和111,824元（人均GDP的1.38倍）。该调查纳入了85名患者，平均WTP为148,443元（人均GDP的1.83倍，95%可信区间120,994 - 175,893），中位数为106,667元（人均GDP的1.32倍）。由于离散程度较大，中位数更具代表性。发现支付方阈值有很高概率（98.5%）落在人均GDP的1 - 2倍范围内，而患者WTP的稳健性相对较弱。
在中国这个实行共付制度的国家，支付方阈值高于患者WTP，这表明医疗保险拥有重大决策权，因此暂时无需考虑患者WTP。
