title: WTP for a QALY and health states: More money for severer health states?
abstract: BACKGROUND
  In economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. Although JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value?
  
  
  METHODS
  To examine the relationship between severity of health status and monetary value of a QALY, we obtained willingness to pay (WTP) values for one additional QALY in eight patterns of health states. We randomly sampled approximately 2,400 respondents from an online panel. To avoid misunderstanding, we randomly allocated respondents to one of 16 questionnaires, with 250 responses expected for each pattern. After respondents were asked whether they wanted to purchase the treatment, double-bounded dichotomous choice method was used to obtain WTP values.
  
  
  RESULTS
  The results clearly show that the WTP per QALY is higher for worse health states than for better health states. The slope was about JPY -1 million per 0.1 utility score increase. The mean and median WTP values per QALY for 16 health states were JPY 5 million, consistent with our previous survey. For respondents who wanted to purchase the treatment, WTP values were significantly correlated with household income.
  
  
  CONCLUSIONS
  This survey shows that QALY based on the EQ-5D does not necessarily have the same monetary value. The WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states.
authors.affiliation: Center for Public Health Informatics, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 3510197, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Shiroiwa
authors.affiliation: Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Igarashi
authors.affiliation: Center for Public Health Informatics, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 3510197, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Department of Pharmaceutical Sciences, School of Pharmacy, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara, Tochigi 3248501, Japan.
authors.forename: Shunya
authors.initials: S
authors.lastname: Ikeda
keywords: Cost-effectiveness analysis; Quality-adjusted life years; Threshold; Willingness-to-pay