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Measuring the End of Life Premium in Cancer using Individual ex ante Willingness to Pay

OLOFSSON, SARA LU ; Gerdtham, Ulf LU ; Hultkrantz, Lars and Persson, Ulf (2016) In Working Papers
Abstract
For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per Quality-Adjusted Life-Years (QALY) gained. Some HTAs 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 value of... (More)
For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per Quality-Adjusted Life-Years (QALY) gained. Some HTAs 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 value of a QALY at EoL in cancer was between €275,000 and €440,000, which is higher than the thresholds applied by HTAs. When expected remaining life expectancy was 6 months, the value of a QALY was 10-20 % higher compared to when remaining life expectancy was 24 months. Order of scenarios did not have a significant impact on the result and the result showed scale sensitivity. Thus this study supports an EoL premium in cancer when expected remaining lifetime is short. (Less)
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author
organization
publishing date
type
Working Paper
publication status
published
subject
keywords
willingness to pay, value of a QALY, cancer, contingent valuation, order bias, D61, D80, I18, J17
in
Working Papers
issue
2016:23
pages
34 pages
publisher
Department of Economics, Lund University
language
English
LU publication?
yes
id
58602f81-aef3-42b1-afa4-f49fea30779e
alternative location
http://swopec.hhs.se/lunewp/abs/lunewp2016_023.htm
date added to LUP
2016-09-30 14:19:10
date last changed
2016-09-30 14:21:40
@misc{58602f81-aef3-42b1-afa4-f49fea30779e,
  abstract     = {For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per Quality-Adjusted Life-Years (QALY) gained. Some HTAs 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 value of a QALY at EoL in cancer was between €275,000 and €440,000, which is higher than the thresholds applied by HTAs. When expected remaining life expectancy was 6 months, the value of a QALY was 10-20 % higher compared to when remaining life expectancy was 24 months. Order of scenarios did not have a significant impact on the result and the result showed scale sensitivity. Thus this study supports an EoL premium in cancer when expected remaining lifetime is short.},
  author       = {OLOFSSON, SARA and Gerdtham, Ulf and Hultkrantz, Lars and Persson, Ulf},
  keyword      = {willingness to pay,value of a QALY,cancer,contingent valuation,order bias,D61,D80,I18,J17},
  language     = {eng},
  number       = {2016:23},
  pages        = {34},
  publisher    = {ARRAY(0x953aef8)},
  series       = {Working Papers},
  title        = {Measuring the End of Life Premium in Cancer using Individual ex ante Willingness to Pay},
  year         = {2016},
}