ABOUT THIS EVENT
OHE’s Lunchtime Seminar Series shines a spotlight on important pieces of research, supporting of our charitable goal of improving the quantity and quality of debate on health economics.
The Value of a QALY towards the End of Life and its Determinants: Experimental Evidence
End-of-life healthcare expenditure (HCE) is a substantial contributor to overall HCE. A widely discussed driver are new drugs with high cost per quality-adjusted life year (QALY); however, little is known about either individual or societal willingness to pay (WTP) for them and for end-of-life medical interventions more generally.
In this study, preferences for end-of-life cancer treatment are elicited using a discrete choice experiment (DCE) via an online survey involving 1,529 Swiss individuals in 2014. The DCE has two parts. In the individual setting, respondents choose between the status quo and a hypothetical drug with varying characteristics and out-of-pocket payments, adopting the perspective of a hypothetical terminal cancer patient. In the societal setting, participants are asked to choose between the status quo and a social health insurance contract with a varying degree of coverage of new cancer drugs for end-of-life treatment and varying insurance premiums.
Evidently, a QALY is not a QALY since WTP values are higher in a societal than in an individual context suggesting altruism and depend on the type of beneficiary. Together with the heterogeneity in the preferences of the Swiss population these findings argue against the use of a uniform QALY threshold in cost-effectiveness analysis.
Peter Zweifel is an Emeritus of the University of Zurich. His publications include more than 170 articles in refereed journals as well as the textbooks Health Economics (with F. Breyer und M. Kifmann). With Mark Pauly (Wharton School, U. of Pennsylvania), he is the founding editor of the International Journal of Health Economics and Management. From 1997 to 2006, he served on the Swiss Competition Authority (Wettbewerbskommission). He has been a consultant to the World Bank and visiting professor to several universities in the US, South Africa, and Australia.