PharmacoEconomics

, Volume 27, Issue 12, pp 1005–1016 | Cite as

Willingness to Pay for a QALY Based on Community Member and Patient Preferences for Temporary Health States Associated with Herpes Zoster

  • Tracy A. Lieu
  • G. Thomas Ray
  • Ismael R. Ortega-Sanchez
  • Ken Kleinman
  • Donna Rusinak
Original Research Article

Abstract

Background and Objectives: A clear sense of what society is willing to pay for a QALY could enhance the usefulness of cost-effectiveness analysis as a field. Scant information exists on willingness to pay (WTP) for a QALY based on direct elicitation of preferences from community members or patients. We had the opportunity to evaluate WTP per QALY using data from a survey on temporary health outcomes related to herpes zoster. Our aims were to (i) describe how much community members are willing to pay to save a QALY based on scenarios describing temporary health states; (ii) evaluate how WTP per QALY varies based on experience with the disease being described and with demographic variables; and (iii) evaluate how the duration and intensity of pain in a scenario influences WTP per QALY.

Methods: Community members drawn from a nationally representative survey research panel (n = 478) completed an Internet-based survey using time trade-off (TTO) and WTP questions to value a series of scenarios that described herpes zoster cases of varying pain intensity (on a scale of 0–10) and duration (30 days to 1 year). Patients with shingles (n = 354) or postherpetic neuralgia (PHN; n = 120) [defined as having symptoms for 90 days or more] from two large healthcare systems completed telephone interviews with similar questions.

Mean and median WTP per QALY values were calculated by dividing the WTP amount by the discounted time traded for each scenario. Responses with a WTP value of more than zero and a TTO value of zero (which would have resulted in an undefined value) were excluded. TTO values were discounted by 3% per year. WTP per QALY means were calculated after trimming the top and bottom 2.5% of responses. Multivariate analyses were conducted using generalized linear mixed models that assumed a negative binomial distribution.

Results: Among all respondents, the WTP per QALY ranged from a median of $US7000 to $US11 000 and a trimmed mean of $US26 000 to $US45 000 (year 2005 values), depending on the scenario described. WTP per QALY values varied significantly with respondent characteristics, as well as among respondents with similar characteristics. In multivariate analyses, the mean WTP per QALY was higher among respondents who were younger, male or had higher educational or income levels. After adjusting for these demographic variables, patients who had experienced shingles gave responses with the highest WTP per QALY values. Patients who had experienced PHN gave the lowest values, and community members gave values intermediate to the shingles and PHN groups. In multivariate models that evaluated the effects of pain and duration of the hypothetical zoster scenario, lower duration was associated with higher WTP per QALY. This effect appeared to be due to people increasing the amounts of time they would be willing to trade as duration increased, without proportional increases in the amounts of money they would be willing to pay.

Conclusions: Community members and patients gave mean WTP per QALY values that varied significantly based on age, sex, socioeconomic status, experience with shingles and duration of the health state evaluated. The variability in WTP per QALY suggests that it may be difficult to define a unitary threshold of dollars per QALY for policy making based on cost-effectiveness analyses.

Keywords

Community Member Herpes Zoster Postherpetic Neuralgia Contingent Valuation Study Temporary Health 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This study was supported by the Joint Initiative in Vaccine Economics Project under cooperative agreements (numbers U01IP000029 and U01IP000143) with the Centers for Disease Control and Prevention (CDC). We are grateful to our collaborators in the original Zoster Utilities Evaluation study, including Katherine Yih, PhD; Irene Shui, MPH; Rafael Harpaz, PhD; and Peter Choo, MD, MPH. We thank our CDC programme officer, Mark Messonnier, PhD, for cogent advice and support throughout this research.

The findings and conclusions expressed are those of the authors and do not necessarily represent the views of the CDC or Department of Health and Human Services. G. Thomas Ray has received research funding from Wyeth for an unrelated study and from Merck for a study related to the epidemiology of herpes zoster. All other authors have no conflicts of interest that are directly relevant to the content of this study.

Supplementary material

40273_2012_27121005_MOESM1_ESM.pdf (183 kb)
Supplementary material, approximately 188 KB.

References

  1. 1.
    Hirth RA, Chernew ME, Miller E, et al. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 2000; 20 (3): 332–42PubMedCrossRefGoogle Scholar
  2. 2.
    Buxton M. Looking for willingness-to-pay (WTP) threshold for a QALY: does it make sense? A practical view. ISPOR Connections 2007 Aug 15; 13 (4): 9–11Google Scholar
  3. 3.
    Gyrd-Hansen D. Looking for willingness to pay (WTP) threshold for a QALY: does it make sense? A critical view. ISPOR Connections 2007 Aug 15; 13 (4): 5–8Google Scholar
  4. 4.
    Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med 2008 Feb 14; 358 (7): 661–3PubMedCrossRefGoogle Scholar
  5. 5.
    Grosse S. Assessing cost-effectiveness in healthcare: history of the $50 000 per QALY threshold. Expert Rev Pharmacoeconomics Outcomes Res 2008; 8: 2165–78CrossRefGoogle Scholar
  6. 6.
    Neumann PJ, Sandberg EA, Bell CM, et al. Are pharmaceuticals cost-effective? A review of the evidence. Health Aff (Millwood) 2000; 19 (2): 92–109CrossRefGoogle Scholar
  7. 7.
    Weinstein M. How much are Americans willing to pay for a quality-adjusted life year? Med Care 2008; 46 (4): 343–5PubMedCrossRefGoogle Scholar
  8. 8.
    Byrne MM, O’Malley K, Suarez-Almazor ME. Willingness to pay per quality-adjusted life year in a study of knee osteoarthritis. Med Decis Making 2005 Nov-Dec; 25 (6): 655–66PubMedCrossRefGoogle Scholar
  9. 9.
    King Jr JT, Tsevat J, Lave JR, et al. Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation. Med Decis Making 2005; 25 (6): 667–77PubMedCrossRefGoogle Scholar
  10. 10.
    Gyrd-Hansen D. Willingness to pay for a QALY. Health Econ 2003 Dec; 12 (12): 1049–60PubMedCrossRefGoogle Scholar
  11. 11.
    Lieu TA, Ortega-Sanchez I, Ray GT, et al. Community and patient values for preventing herpes zoster. Pharmacoeconomics 2008; 26 (3): 235–49PubMedCrossRefGoogle Scholar
  12. 12.
    International classification of diseases. 9th ed. Geneva: World Health Organization, 1977Google Scholar
  13. 13.
    Gold M, Siegel J, Russell L, et al. Cost-effectiveness in health and medicine. New York: Oxford University, 1996Google Scholar
  14. 14.
    Efron B, Tibshirani R. An introduction to the bootstrap. New York: Chapman and Hall, 1993Google Scholar
  15. 15.
    Baron J, Asch DA, Fagerlin A, et al. Effect of assessment method on the discrepancy between judgments of health disorders people have and do not have: a web study. Med Decis Making 2003; 23 (5): 422–34PubMedCrossRefGoogle Scholar
  16. 16.
    Ubel PA, Loewenstein G, Jepson C. Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public. Qual Life Res 2003; 12 (6): 599–607PubMedCrossRefGoogle Scholar
  17. 17.
    Van Houtven G, Powers J, Jessup A, et al. Valuing avoided morbidity using meta-regression analysis: what can health status measures and QALYs tell us about WTP? Health Econ 2006 Aug; 15 (8): 775–95PubMedCrossRefGoogle Scholar
  18. 18.
    Messonnier M, Zhou F. Review of economic studies of varicella zoster vaccine [oral presentation]. Advisory Committee on Immunization Practices (ACIP) Meeting; 2006 Oct 25; Atlanta (GA)Google Scholar
  19. 19.
    Hornberger J, Robertus K. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Intern Med 2006 Sep 5; 145 (5): 317–25PubMedGoogle Scholar
  20. 20.
    Rothberg MB, Virapongse A, Smith KJ. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Clin Infect Dis 2007 May 15; 44 (10): 1280–8PubMedCrossRefGoogle Scholar
  21. 21.
    Pellissier J. Evaluation of zoster vaccine cost-effectiveness [oral presentation]. Advisory Committee of Immunization Practices (ACIP) Meeting; 2006 Jun 30; Atlanta (GA)Google Scholar
  22. 22.
    Ortega-Sanchez IR. Projected cost-effectiveness of vaccinating US elderly to prevent shingles [oral presentation]. Advisory Committee for Immunization Practices (ACIP) Meeting; 2006 Jun 30; Atlanta (GA)Google Scholar
  23. 23.
    Pellissier JM, Brisson M, Levin MJ. Evaluation of the costeffectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Vaccine 2007 Nov 28; 25 (49): 8326–37PubMedCrossRefGoogle Scholar
  24. 24.
    Ho AMH, Coplan P, Lee A, et al. Cost-effectiveness of varicella zoster vaccination in older adults [abstract]. Can J Anethesia 2006; 53 Suppl. 1: 26394CrossRefGoogle Scholar
  25. 25.
    Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008 Jun 6; 57 (RR-5): 1–30; quiz CE2-4PubMedGoogle Scholar
  26. 26.
    Braithwaite RS, Meltzer DO, King Jr JT, et al. What does the value of modern medicine say about the $50 000 per qualityadjusted life-year decision rule? Med Care 2008; 46 (4): 349–56PubMedCrossRefGoogle Scholar
  27. 27.
    Gyrd-Hansen D. Willingness to pay for a QALY: theoretical and methodological issues. Pharmacoeconomics 2005; 23 (5): 423–32PubMedCrossRefGoogle Scholar
  28. 28.
    Smith RD, Richardson J. Can we estimate the ‘social’ value of a QALY? Four core issues to resolve. Health Policy 2005 Sep 28; 74 (1): 77–84PubMedCrossRefGoogle Scholar
  29. 29.
    Hammitt J, Haninger K. Willingness to pay for food safety: sensitivity to duration and severity of illness. Amer J Agr Econ 2007; 89 (5): 1170–5CrossRefGoogle Scholar
  30. 30.
    Hammitt J, Graham JD. Willingness to pay for health protection: inadequate sensitivity for probability? J Risk Uncertainty 1999; 18 (1): 33–62CrossRefGoogle Scholar
  31. 31.
    Oliver A, Sorenson C. Importance of preference reversals in the valuation of health and healthcare. Expert Rev Pharmacoeconomics Outcomes Res 2008; 8 (2): 95–9CrossRefGoogle Scholar
  32. 32.
    Krosnick J, LinChiat C. A comparison of the random digit dialing telephone survey methodology as implemented by Knowledge Networks and Harris Interactive [presentation]. Conference of the American Association for Public Opinion Research; 2001 May 17-20; Montreal (QC)Google Scholar
  33. 33.
    Lenert LA. The reliability and internal consistency of an Internet-capable computer program formeasuring utilities. Qual Life Res 2000; 9 (7): 811–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Tracy A. Lieu
    • 1
    • 2
  • G. Thomas Ray
    • 3
  • Ismael R. Ortega-Sanchez
    • 4
  • Ken Kleinman
    • 1
  • Donna Rusinak
    • 1
  1. 1.Department of Ambulatory Care and PreventionHarvard Pilgrim Health Care and Harvard Medical SchoolBostonUSA
  2. 2.Division of General PediatricsChildren’s HospitalBostonUSA
  3. 3.Division of ResearchKaiser PermanenteOaklandUSA
  4. 4.National Center for Immunizations and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaUSA

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