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Measuring the end-of-life premium in cancer using individual ex ante willingness to pay

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Abstract

For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per quality-adjusted life-year (QALY) gained. Some HTA agencies accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so-called end-of-life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20–80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The mean value of a QALY was MSEK4.8 (€528,000), and there was an EoL premium of 4–10% at 6 months of expected remaining lifetime. Using subjective risk resulted in more robust and valid estimates of the value of a QALY. Order of scenarios did not have a significant impact on the WTP and the result showed scale sensitivity. Our result provides some support for the use of an EoL premium based on individual preferences when expected remaining lifetime is short and below 24 months. Furthermore, we find support for a value of a QALY that is above the current threshold of several HTA agencies.

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Notes

  1. This calculation is based on the VSL divided by the discounted number of QALYs lost in a fatal road traffic accident (16.23) and adjusted for tax factors used in the transport sector (1.53).

  2. The review found a large variation of QoL in cancer ranging from 0.33 to 0.93. Most QoL measurements were, however, above 0.5. Since the cancer type in the questionnaire is fatal, it was found reasonable to apply 0.6 as a mean average and 0.4 was considered appropriate for the last month alive.

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Author information

Authors and Affiliations

  1. The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden

    S. Olofsson, U.-G. Gerdtham & U. Persson

  2. Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden

    S. Olofsson & U.-G. Gerdtham

  3. School of Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden

    U.-G. Gerdtham & U. Persson

  4. Department of Economics, School of Economics and Management, Lund University, Lund, Sweden

    U.-G. Gerdtham

  5. School of Business, Örebro University, Örebro, Sweden

    L. Hultkrantz

Authors
  1. S. Olofsson
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  2. U.-G. Gerdtham
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  3. L. Hultkrantz
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  4. U. Persson
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Corresponding author

Correspondence to S. Olofsson.

Ethics declarations

Funding

Janssen Pharmaceutica NV funded the project through an unrestricted Grant to IHE.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics

The study is a survey of the general population. No ethical approval was applied for since participants could not be identified and the study did not involve collection of sensitive information.

Appendix

Appendix

Cancer death

10-year risk (per 1000)

Age

Men

Women

20

1

1

21

1

1

22

1

1

23

1

1

24

1

1

25

1

1

26

1

1

27

1

1

28

1

1

29

1

1

30

1

1

31

1

2

32

2

2

33

2

2

34

2

2

35

2

3

36

2

3

37

3

3

38

3

4

39

3

4

40

3

5

41

4

5

42

5

6

43

5

7

44

6

8

45

7

8

46

8

10

47

9

11

48

10

12

49

12

14

50

13

15

51

15

17

52

17

18

53

20

20

54

22

22

55

24

24

56

28

27

57

31

29

58

35

32

59

38

35

60

42

37

61

47

41

62

53

45

63

58

48

64

63

52

65

69

55

66

77

60

67

85

64

68

93

69

69

101

73

70

109

78

71

121

84

72

133

90

73

145

95

74

156

101

75

168

107

76

184

114

77

201

121

78

217

129

79

234

136

80

250

143

  1. Ref = The National Board of Health and Welfare (NBHW), Cause of death registry, Diagnosis C00-D48 (tumors), Number of deaths per 100,000 persons in 2014. Some risks for lower ages (men <28 years and women <25 years) are rounded to 1

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Olofsson, S., Gerdtham, UG., Hultkrantz, L. et al. Measuring the end-of-life premium in cancer using individual ex ante willingness to pay. Eur J Health Econ 19, 807–820 (2018). https://doi.org/10.1007/s10198-017-0922-6

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