Cost-effectiveness analysis provides a crucial means for evidence-informed decision-making on resource allocation. This study aims to elicit individuals' willingness to pay (WTP) for one additional quality-adjusted life-year (QALY) gained from life-saving treatment and associated factors in Kermanshah city, western Iran.
We conducted a cross-sectional study on a total of 847 adults aged 18 years and above to elicit their WTP for one additional QALY gained by oneself and a family member using a hypothetical life-saving treatment. We used a multistage sampling technique to select the samples, and the Iranian version of EQ-5D-3L, and visual analogue scale (VAS) measures was used to obtain the participants’ health utility value. The Tobit regression model was used to identify the factors affecting WTP per QALY values.
The mean WTP value and standard deviation (SD) was US$ 862 (3224) for the respondents and US$ 1355 (3993) for the family members. The mean utility values using EQ-5D-3L and VAS methods were 0.779 and 0.800, respectively. The WTP for the additional QALY gained by the individual participants using the EQ-5D-3L and VAS methods were respectively US$ 1202 and US$ 1101, while the estimated value of the family members was US$ 1355 (SD= 3993). The Tobit regression models indicated that monthly income, education level, sex, and birthplace were statistically significantly associated (p < 0.05) with both the WTP for the extra QALY values using the EQ-5D-3L and the VAS methods. Besides, education level and monthly income showed statistically significant relationships with the WTP for the additional QALY gained by the family members (p < 0.05).
Our findings indicated that the participants' WTP value of the additional QALY gained from the hypothetical life-saving treatment was in the rage of 0.20 to 0.24 of Iran’s gross domestic product (GDP) per capita, which is far lower than the World Health Organization (WHO) recommended CE threshold value of one. This wide gap reflects the challenges the health system is facing and requires further research for defining the most appropriate CE threshold at the local level.