Yao Ying, Rahman Md Mizanur, Teerawattananon Yot, Nakamura Ryota
Faculty of Economics, Keio University, Tokyo, Japan.
Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan.
BMJ Glob Health. 2025 Aug 21;10(8):e019098. doi: 10.1136/bmjgh-2025-019098.
Context-specific cost-effectiveness thresholds (CETs) informed by societal willingness to pay (WTP) are crucial for healthcare resource allocation in low- and middle-income countries. This study investigated WTP for health per quality-adjusted life year (QALY) in Bhutan.
A WTP survey was conducted alongside the 2023 National Health Survey in Bhutan, sampling 1869 households. Using contingent valuation, respondents assigned monetary values to three hypothetical scenarios: 1 year of cancer symptom-free life, 1 year of perfect health and 5 years of perfect health. We used generalised linear regression to estimate WTP, controlling for demographic, socioeconomic and health-related factors, as well as elicitation methods. Multilevel analyses examined WTP variations within and between districts.
WTP estimates were 76 836 Bhutanese ngultrum (BTN) (0.26 times gross domestic product (GDP) per capita; 95% CI: 71 397 to 82 275) for a year without cancer symptoms, 104 381 BTN (0.35 times GDP per capita; 95% CI: 96 405 to 112 357) for 1 QALY and 235 237 BTN (0.78 times GDP per capita; 95% CI: 218 674 to 251 800) for 5 QALYs. WTP variations were driven by within-district individual characteristics, particularly income and education, rather than between-district differences.
Minimal between-district WTP variations support a national-level CET for Bhutan. However, WTP-based CETs would be biased upward by wealthier and more educated groups. This bias could justify expensive technologies that strain public resources in Bhutan's government-funded healthcare system.
基于社会支付意愿（WTP）的特定情境成本效益阈值（CET）对于低收入和中等收入国家的医疗资源分配至关重要。本研究调查了不丹每质量调整生命年（QALY）的健康支付意愿。
在2023年不丹全国健康调查期间开展了一项支付意愿调查，对1869户家庭进行了抽样。采用条件估值法，让受访者为三种假设情景赋予货币价值：1年无癌症症状的生活、1年完全健康和5年完全健康。我们使用广义线性回归来估计支付意愿，控制人口统计学、社会经济和健康相关因素以及诱导方法。多层次分析考察了各地区内部和地区之间支付意愿的差异。
无癌症症状一年的支付意愿估计值为76836不丹努尔特鲁姆（BTN）（人均国内生产总值（GDP）的0.26倍；95%置信区间：71397至82275），1个QALY的支付意愿为104381 BTN（人均GDP的0.35倍；95%置信区间：96405至112357），5个QALYs的支付意愿为235237 BTN（人均GDP的0.78倍；95%置信区间：218674至251800）。支付意愿的差异是由地区内部的个体特征驱动的，特别是收入和教育，而不是地区之间的差异。
各地区之间支付意愿的差异最小，这支持了不丹的国家级成本效益阈值。然而，基于支付意愿的成本效益阈值会因较富裕和受教育程度较高的群体而向上偏差。这种偏差可能会使不丹政府资助的医疗系统中耗费公共资源的昂贵技术合理化。
