Contingent Valuation of Eight New Treatments: What is the Clinician's and Politician's Willingness to Pay?

ABSTRACT

Objective: To assess the willingness to pay (WTP) for eight new treatments from a life-long perspective. Methods: A contingent valuation with virtual examples and dichotomous choice questions is circulated to Finnish clinicians (N 146) and politicians (N 73). Costs and utilities (15D, EQ-5D) are obtained from Finnish sources, and the health care payer perspective is assumed. Health benefits are measured using life-years gained (LYG) and quality-adjusted life-years (QALY) gained, and 3% and 0% annual discounting is done. The results are presented as different WTP thresholds (incremental and aggregate cost-effectiveness ratios, and incremental investments, II). Heterogeneity is handled using conditional (Hurdle) modeling. Results: In 1,092 decisions, the mean discounted (undiscounted) incremental WTP/QALY gained is € 102,616 (€ 78,686) and € 94,770 (€ 77,856) measured with 15D and EQ-5D, respectively. The mean discounted (undiscounted) incremental WTP/LYG is € 66,277 (€ 58,160). The highest incremental WTPs are reported for cancer (€ 205,994–250,509/QALY gained) and lowest for metabolic disease (€ 23,492–43,398/QALY gained) treatment. The discounted (undiscounted) IIs to health care are € 83,886 (€ 85,398) Euros; metabolic presenting the highest (€ 199,499-213,808) and coronary heart disease treatment (€ 36,124-36,736) the lowest value for the lifetime of the patient. WTP is dependent upon disease/treatment, patient's age, time preference, health benefit type and discounting. Minor differences between clinicians and politicians are observed. Conclusion: WTP vary for different diseases and is not explained by incremental costs. Thus, a single WTP for all treatments/diseases hypothesis do not gain empirical support - WTP is better explained by treatment and patient/disease characteristics. Cost-effectiveness and II have a trade-off, which encourages studies including both efficiency and affordability.

Keywords:

Budget , impact, cost allocation, cost-utility, decision making, discrete choice, economic evaluation, quality of life, willingness to pay.