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Willingness to Pay per Quality-Adjusted Life Year: Is One Threshold Enough for Decision-Making?: Results From a Study in Patients With Chronic Prostatitis

Zhao, Fei-Li MS*; Yue, Ming MD; Yang, Hua MD; Wang, Tian MD; Wu, Jiu-Hong PhD§; Li, Shu-Chuen PhD, MBA*

doi: 10.1097/MLR.0b013e31820192cd
Original Article

Objective: To estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) ratio with the stated preference data and compare the results obtained between chronic prostatitis (CP) patients and general population (GP).

Methods: WTP per QALY was calculated with the subjects' own health-related utility and the WTP value. Two widely used preference-based health-related quality of life instruments, EuroQol (EQ-5D) and Short Form 6D (SF-6D), were used to elicit utility for participants' own health. The monthly WTP values for moving from participants' current health to a perfect health were elicited using closed-ended iterative bidding contingent valuation method.

Results: A total of 268 CP patients and 364 participants from GP completed the questionnaire. We obtained 4 WTP/QALY ratios ranging from $4700 to $7400, which is close to the lower bound of local gross domestic product per capita, a threshold proposed by World Health Organization. Nevertheless, these values were lower than other proposed thresholds and published empirical researches on diseases with mortality risk. Furthermore, the WTP/QALY ratios from the GP were significantly lower than those from the CP patients, and different determinants were associated with the within group variation identified by multiple linear regression.

Conclusions: Preference elicitation methods are acceptable and feasible in the socio-cultural context of an Asian environment and the calculation of WTP/QALY ratio produced meaningful answers. The necessity of considering the QALY type or disease-specific QALY in estimating WTP/QALY ratio was highlighted and 1 to 3 times of gross domestic product/capita recommended by World Health Organization could potentially serve as a benchmark for threshold in this Asian context.

From the *School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia; †Department of Urology, 306 Hospital of PLA, Beijing, China; and ‡Department of Urology, The First People's Hospital of Yunnan Province, Yunnan, China; and §Department of Pharmacy, 306 Hospital of PLA, Beijing, China.

Jiu-Hong Wu and Shu-Chuen Li contributed equally to this study.

Reprints: Shu-Chuen Li, PhD, MBA, Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.