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

Olofsson, S. LU ; Gerdtham, U. G. LU ; Hultkrantz, Malin L and Persson, U. LU (2017) In European Journal of Health Economics p.1-14
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... (More)

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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author
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Cancer, Contingent valuation, End of life, Individual preferences, Value of a QALY, Willingness to pay
in
European Journal of Health Economics
pages
14 pages
publisher
Springer
external identifiers
  • scopus:85027379799
  • pmid:28803265
ISSN
1618-7598
DOI
10.1007/s10198-017-0922-6
language
English
LU publication?
yes
id
2c85eda1-5fa7-46c2-af57-5b365f5cc697
date added to LUP
2017-09-04 13:25:05
date last changed
2017-09-12 13:01:09
@article{2c85eda1-5fa7-46c2-af57-5b365f5cc697,
  abstract     = {<p>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.</p>},
  author       = {Olofsson, S. and Gerdtham, U. G. and Hultkrantz, Malin L and Persson, U.},
  issn         = {1618-7598},
  keyword      = {Cancer,Contingent valuation,End of life,Individual preferences,Value of a QALY,Willingness to pay},
  language     = {eng},
  month        = {08},
  pages        = {1--14},
  publisher    = {Springer},
  series       = {European Journal of Health Economics},
  title        = {Measuring the end-of-life premium in cancer using individual ex ante willingness to pay},
  url          = {http://dx.doi.org/10.1007/s10198-017-0922-6},
  year         = {2017},
}