Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation.
BACKGROUND
Health-state preferences can be combined with willingness-to-pay (WTP) data to calculate WTP per quality-adjusted life year (QALY). The WTP/QALY ratios provide insight into societal valuations of expenditures for medical interventions.


METHODS
The authors measured preferences for current health in 3 patient populations (N = 391) using standard gamble, time trade-off, visual analog scale, and WTP, then they calculated WTP/QALY ratios. The ratios were compared with several proposed cost/QALY cost-effectiveness ratio thresholds, the value-of-life literature, and with WTP/QALY ratios derived from published preference research.


RESULTS
Mean WTP/QALY ratios ranged from 12,500 to 32,200 US dollars (2003 US dollars). All values were below most published cost-effectiveness ratio thresholds, below the ratio from a prototypic medical treatment covered by Medicare (i.e., renal dialysis), and below ratios from the value-of-life literature. The WTP/QALY ratios were similar to those calculated from published preference data for patients with symptomatic meno-pause, dentofacial deformities, asthma, or dermatologic disorders.


CONCLUSIONS
WTP/QALY ratios calculated using preference data collected from diverse populations are lower than most proposed thresholds for determining what is "cost-effective." Current proposed cost-effectiveness ratio thresholds may overestimate the willingness of society to pay for medical interventions.
King
Joseph T
JT
VA Connecticut Healthcare System, West Haven, CT, USA. Joseph.KingJr@med.va.gov
Tsevat
Joel
J
Lave
Judith R
JR
Roberts
Mark S
MS
D000328:Adult; D000368:Aged; D005260:Female; D005382:Financing, Personal; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years