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QALY-type preference and willingness-to-pay among end-of-life patients with cancer treatments: a pilot study using discrete choice experiment

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Abstract

Purpose

Quality-adjusted life-year (QALY) is a dominant measurement of health gain in economic evaluations for pricing drugs. However, end-of-life (EoL) patients’ preference for QALY gains in life expectancy (LE) and quality of life (QoL) during different disease stages remains unknown and is seldom involved in decision-making. This study aims to measure preferences and willingness-to-pay (WTP) towards different types of QALY gain among EoL cancer patients.

Methods

We attributed QALY gain to four types, gain in LE and QoL, respectively, and during both progression-free survival (PFS) and post-progression survival (PPS).

A discrete choice experiment including five attributes (the four QALY attributes and one cost attribute) with three levels each was developed and conducted with 85 Chinese advanced non-small cell lung cancer patients in 2022. All levels were set with QALY gain/cost synthesised from research on anti-lung cancer drugs recently listed by Chinese National Healthcare Security Administration. Each respondent answered six choice tasks in a face-to-face interview. The data were analysed using mixed logit models.

Results

Patients valued LE-related QALY gain in PFS most, with a relative importance of 81.8% and a WTP of $43,160 [95% CI 26,751 ~ 59,569] per QALY gain. Respondents consistently preferred LE-related to QoL-related QALY gain regardless of disease stage. Patients with higher income or lower education levels tended to pay more for QoL-related QALY gain.

Conclusion

Our findings suggest a prioritised resource allocation to EoL-prolonging health technologies. Given the small sample size and large individual heterogeneity, a full-scale study is needed to provide more robust results.

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Data availability

The datasets analysed during this study are available from the corresponding author on reasonable request.

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Funding

This study was funded by General Program of National Natural Science Foundation of China (72174207), General Program of National Natural Science Foundation of China (72374214) and Postgraduate Research & Practice Innovation Program of Jiangsu Province (SJCX23_0232).

Author information

Author notes

  1. Yue Yin and Qian Peng have contributed equally to this work.

Authors and Affiliations

  1. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China

    Yue Yin, Qian Peng, Longhao Ma, Yi Dong, Yinan Sun, Mingye Zhao, Yaqian Tang, Zhiqing Mei, Hanqiao Shao & Wenxi Tang

  2. Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China

    Yue Yin, Qian Peng, Mingye Zhao, Yaqian Tang, Zhiqing Mei, Hanqiao Shao & Wenxi Tang

  3. Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China

    Silu Xu, Nianyang Ding, Xiaolin Liu & Dan Yan

  4. School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China

    Dan Yan

  5. Department of Public Management, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China

    Wenxi Tang

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Contributions

WT, YY and QP were involved in conceptualisation and methodology. DY, YY, QP, LM, YD, YS, SX, ND, XL, YT, ZM and HS were involved in formal analysis and investigation. YY was involved in writing—original draft preparation. WT, YY and MZ were involved in writing—review and editing. WT was involved in funding acquisition and supervision. DY was involved in resources.

Corresponding authors

Correspondence to Dan Yan or Wenxi Tang.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

The questionnaire and methodology for this study were approved by the Ethics Committee of Jiangsu Cancer Hospital on 31 March 2022 (Ethics approval number: 2022KY-KS017).

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Informed consent was obtained from all individual participants included in the study.

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Yin, Y., Peng, Q., Ma, L. et al. QALY-type preference and willingness-to-pay among end-of-life patients with cancer treatments: a pilot study using discrete choice experiment. Qual Life Res 33, 753–765 (2024). https://doi.org/10.1007/s11136-023-03562-3

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