Willingness to Pay for Health-Related Quality of Life Gains in Relation to Disease Severity and the Age of Patients

Highlights

• Equity weights are increasingly used in decision-making frameworks that draw on health-economic evaluations. These weights can be attached to health gains or reflected in the monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated. Currently applied weights are based on different definitions of patients’ disease severity and do not account for age-related preferences in society. However, empirical evidence suggests that the public considers age to be an important equity-relevant characteristic.

• Societal preferences for equity weighting are infrequently elicited in monetary terms. This study examines the willingness to pay (WTP) for health-related quality-of-life (QOL) gains in relation to patients’ disease severity and age. It also examines whether the WTP differs between gains in patients who fully recover and patients who die. Using WTP (in terms of an increase in basic health-insurance premium) relates directly to the payment vehicle used for collectively funding healthcare in The Netherlands.

• Our results indicate that the WTP is higher for QOL gains in patients with a higher level of disease severity and younger age and larger-sized QOL gains. It is lower for gains in patients who die than in those who fully recover. However, the relations are nonlinear and context dependent. Our results suggest that—if the aim is to align resource-allocation decisions in healthcare with societal preferences—currently applied equity weights do not suffice.

Abstract

Objectives

Decision-making frameworks that draw on economic evaluations increasingly use equity weights to facilitate a more equitable and fair allocation of healthcare resources. These weights can be attached to health gains or reflected in the monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated. Currently applied weights are based on different definitions of disease severity and do not account for age-related preferences in society. However, age has been shown to be an important equity-relevant characteristic. This study examines the willingness to pay (WTP) for health-related quality of life (QOL) gains in relation to the disease severity and age of patients, and the outcome of the disease.

Methods

We obtained WTP estimates by applying contingent-valuation tasks in a representative sample of the public in The Netherlands (n = 2023). We applied random-effects generalized least squares regression models to estimate the effect of patients’ disease severity and age, size of QOL gains, disease outcome (full recovery/death 1 year after falling ill), and respondent characteristics on the WTP.

Results

Respondents’ WTP was higher for more severely ill and younger patients and for larger-sized QOL gains, but lower for patients who died. However, the relations were nonlinear and context dependent. Respondents with a lower age, who were male, had a higher household income, and a higher QOL stated a higher WTP for QOL gains.

Conclusions

Our results suggest that—if the aim is to align resource-allocation decisions in healthcare with societal preferences—currently applied equity weights do not suffice.